Abstract:
Osteoporotic vertebral fractures frequently result in pain and decreased quality of life (QoL). The management of these fractures remains a topic of debate. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we analyzed randomized controlled trials comparing percutaneous vertebroplasty (PV) with non-operative treatment (non-OT). The outcomes of interest included pain, QoL, cement leakage, and new osteoporotic vertebral fractures after 1 year. Compared to non-OT regarding pain relief, PV yielded significant improvement at 1-2 weeks, 1 month, 6 months (standard mean difference [SMD] = -0.67 (6/14; 95% confidence interval [CI]: -1.29 to -0.06; I2 = 92%, random effects) and 1 year (mean difference = -1.07 (4/14; 95% CI: -1.97 to -0.18; I2 = 97%, random effects). For QoL, notable improvements were observed at 1 week (standard mean difference = -2.10 (5/14; 95% CI: -3.77 to -0.42; I2 = 98%, random effects) and 3 months (mean difference = -1.58 (4/14; 95% CI: -3.07 to -0.09; I2 = 96%, random effects), with 1 month, 6 months and 1 year being inconclusive. A cement leakage rate of 42% (10/14; 95% CI: 25% to 59%; I2 = 99%, random effects) was found. Further, PV did not significantly heighten the risk of new fractures within a year (odds ratio = 1.26 (6/14; 95% CI: 0.63 to 2.53; I2 = 74%, random effects). PV emerges as a promising intervention for specific time intervals regarding pain relief, especially in the extended-term analysis, and QoL, especially in the short-term analysis, compared to non-OT. However, clinicians must consider cement leakage risks. Heterogeneity among studies underscores careful patient selection.
摘要:
骨质疏松性椎体骨折(OVFs)经常导致疼痛和生活质量(QoL)下降。这些骨折的管理仍然是一个争论的话题。按照PRISMA准则,我们分析了比较PV和非手术治疗(非OT)的RCT。感兴趣的结果包括疼痛,QoL,水泥渗漏,和一年后的新OVF。与非OT相比,疼痛缓解,PV在1-2周显著改善,1个月,6个月(SMD=-0.67(6/14;95%CI:-1.29至-0.06;I2=92%,随机效应)和1年(MD=-1.07(4/14;95%CI:-1.97至-0.18;I2=97%,随机效应)。对于QoL,在1周时观察到显着改善(SMD=-2.10(5/14;95%CI:-3.77至-0.42;I2=98%,随机效应)和3个月(MD=-1.58(4/14;95%CI:-3.07至-0.09;I2=96%,随机效应),1个月,6个月和1年没有定论。水泥渗漏率为42%(10/14;95%CI:25%至59%;I2=99%,随机效应)被发现。Further,PV并没有显着增加一年内新骨折的风险(OR=1.26(6/14;95%CI:0.63至2.53;I2=74%,随机效应)。PV作为一种有希望的干预措施,用于缓解疼痛的特定时间间隔,特别是在长期分析中,和QoL,特别是在短期分析中,与非OT相比。然而,临床医生必须考虑水泥渗漏的风险。研究之间的异质性强调了谨慎的患者选择。