目的 探讨经皮椎体成形术治疗骨质疏松性椎体压缩性骨折的有效性和安全性。方法 全面检索维普中文期刊服务平台、中国知网、万方医学网、Pubmed、Embase、Scopus和Web of Science等中英文数据库中的相关研究,比较椎体成形术对急性期、亚急性期和慢性期患者的疗效,采用均值差异（MD）和风险差异（RD）作为合并变量,选择95%作为置信区间（CI）。结果 最终纳入了9项临床研究,共678例患者。结果显示,早期经皮椎体成形术较延期手术能够减少术后椎体再骨折的发生率（RD：-0.13;95%CI：-0.21~-0.05;P=0.002）,并在术后Cobb角恢复中更有优势（MD：-5.96;95%CI：-11.78~-0.14;P=0.04）,而延期手术中椎体骨水泥注入量更少（MD=1.24;95% CI： 0.57 ~ 1.91;P=0.0003）。两组患者在术后骨水泥渗漏、VAS评分、ODI指数上表现相当。结论 在骨质疏松性椎体压缩性骨折的治疗过程中,虽然延期手术的骨水泥注入量更小,但早期行经皮椎体成形术能够降低术后椎体再骨折发生率,并能获得更理想的术后Cobb角。
Abstract
Objective To investigate the efficacy and safety of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures under different surgical timing. Methods Comprehensive search was conducted in both Chinese and English databases such as VIP Chinese Journal Service Platform, China National Knowledge Infrastructure （CNKI）, Wanfang Medical Network, PubMed, Embase, Scopus, and Web of Science. The efficacy differences of vertebroplasty in patients at the acute, subacute, and chronic stages were compared. Mean differences （MDs） and risk differences （RDs） were employed as combined variables,and 95% was selected as the confidence interval （CI）. Results A total of 9 clinical studies were included, involving 678 patients. The findings showed that early percutaneous vertebroplasty could reduce the incidence of postoperative vertebral refracture compared with delayed surgery（RD：-0.13;95%CI：-0.21~-0.05;P=0.002）, and had more advantages in postoperative Cobb angle recovery（MD: -5.96; 95%CI：-11.78~ -0.14;P=0.04）,while the volume of injected vertebral bone cement in delayed surgery was notably lower（MD: 1.24; 95% CI： 0.57 ~ 1.91;P=0.0003）. There were no significant differences between the two groups regarding postoperative bone cement leakage,VAS scores,and ODI indices. Conclusions In the treatment of osteoporotic vertebral compression fractures,early percutaneous vertebroplasty can effectively decrease the incidence of postoperative vertebral refracture and achieve better postoperative Cobb angle, although the amount of bone cement injection is smaller after delayed surgery.
关键词
经皮椎体成形术 /
手术时机 /
骨质疏松性椎体压缩骨折 /
Meta分析
Key words
percutaneous vertebroplasty /
surgical timing /
osteoporotic vertebral compression fracture /
Meta-analysis
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