目的:经皮椎体成形术(PVP)和椎体后凸成形术(PKP)已广泛用于治疗骨质疏松性椎体压缩性骨折(OVCF)。但PVP/PKP术后椎体再骨折的风险仍存在争议.本研究旨在探讨PVP/PKP术后椎体再骨折的发生率及危险因素。
方法:截至2021年11月发表的相关文献来自PubMed,Embase和WebofScience。根据PRISMA指南进行荟萃分析,以提取与SVCF危险因素相关的数据。此外,采用95%置信区间(CI)计算合并比值比(OR)或加权平均差(WMD).
结果:共有23项研究,包括9372名OVCF患者,符合纳入标准。1255例(13.39%)患者在PVP/PKP手术后再次骨折。共有22项研究来自东亚,只有1项研究来自欧洲。女性(OR=1.34,95CI1.09-1.64,P=0.006),年龄较大(WMD=2.04,95CI0.84-3.24,P=0.001),较低的骨密度(骨密度,WMD=-0.38,95CI-0.49-0.26,P<0.001)和骨水泥渗漏(OR=2.05,95%CI1.40-3.00,P<0.001)增加了SVCF的风险。亚组分析结果显示再骨折的发生与性别显著相关(P=0.002),东亚地区的年龄(P=0.001)和骨密度(P<0.001)。与未骨折组相比,前后椎体高度比(AP比,WMD=0.06,95CI0.00-0.12,P=0.037)和视觉模拟量表评分(VAS,WMD=0.62,95CI0.09-1.15,P=0.022)在再骨折组中较高,和后倾角校正比(Cobb比,东亚地区的WMD=-0.72,95CI-1.26-0.18,P=0.008)较小。此外,抗骨质疏松治疗(OR=0.40,95%CI0.27~0.60,P<0.001)可能是保护因素。
结论:与PVP/PKP术后再骨折相关的主要因素是性别,年龄,骨矿物质密度,AP比率,Cobb比,VAS评分,骨水泥渗漏和抗骨质疏松治疗,尤其是在东亚。
OBJECTIVE: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP.
METHODS: Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated.
RESULTS: A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09-1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84-3.24, P = 0.001), lower bone mineral density (BMD, WMD = - 0.38, 95%CI - 0.49-0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40-3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00-0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09-1.15, P = 0.022) were higher in the
refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = - 0.72, 95%CI - 1.26-0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27-0.60, P < 0.001) could be a protective factor.
CONCLUSIONS: The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.