目的:目前的荟萃分析旨在收集有关脊柱转移手术患者骨水泥渗漏(CL)发生率和危险因素的现有证据。
方法:两位作者独立搜索了PubMed,Embase,和中央数据库。纳入报告CL发生率或危险因素的临床研究进行分析。分析的主要结果是各种类型CL的发生率。进行随机效应或固定效应单比例荟萃分析,以汇集现有证据,基于异质性检验。根据外科手术进行亚组分析(PVP,PKP及其他)。对CL的危险因素进行叙述性综合,以确定最普遍接受的因素。
结果:共26项研究,涉及2551名患者,包括在内。23项研究报告了手术脊柱节段的数量,占4101椎骨。一般的汇总事件,椎间盘内,椎旁,椎管和血管内CLs为0.18(95CI:0.11-0.28),0.14(95CI:0.08-0.21),0.13(95CI:0.06-0.21),0.11(95CI:0.05-0.19),和0.12(95CI:0.08-0.17),分别。亚组分析显示,一般CL的发生率显着不同(0.37vs.0.06vs.0.09,p<0.01),椎间盘内CL(0.22vs.0.06vs.0.12,p<0.01),椎旁CL(0.25vs.0.03vs.0.06,p<0.01),和血管CL(0.14vs.0.03vs.0.15,p<0.01),在三个群体中。后壁破裂,病理性骨折,和治疗的椎体水平数是一般CL最常见的独立危险因素。后壁破裂被确定为椎管CL的常见重要危险因素。
结论:这篇综述提供了脊柱转移手术中与CL相关的发生率和危险因素的见解。了解这些风险因素可以有助于制定旨在最大程度地减少CL发生率和优化脊柱转移性手术患者手术结果的定制策略。
The current meta-analysis was performed to gather available evidence regarding the incidence and risk factors of cement leakage (CL) in patients undergoing surgical procedures for spinal metastasis.
Two authors independently searched the PubMed, Embase, and CENTRAL databases. Clinical studies reporting the incidence or risk factors of CL were included for analysis. The primary outcome analyzed was the incidence of various types of CL. Random-effects or fixed-effects single-proportion meta-analyses were conducted to pool the available evidence, based on the heterogeneity test. Subgroup analyses were conducted based on surgical procedures (percutaneous vertebroplasty, percutaneous kyphoplasty, and others). Risk factors of CL were synthesized narratively to identify the most commonly accepted factors.
A total of 26 studies, involving 2551 patients, were included. The number of operated spine segments was reported in 23 studies, accounting for 4101 vertebrae. The pooled incidences of general, intradiscal, paravertebral, spinal canal, and intravascular CLs were 0.18 (95% confidence interval [CI], 0.11-0.28), 0.14 (95% CI, 0.08-0.21), 0.13 (95% CI, 0.06-0.21), 0.11 (95% CI, 0.05-0.19), and 0.12 (95% CI, 0.08-0.17), respectively. Subgroup analyses revealed significantly different incidences of general CL (0.37 vs. 0.06 vs. 0.09, P < 0.01), intradiscal CL (0.22 vs. 0.06 vs. 0.12, P < 0.01), paravertebral CL (0.25 vs. 0.03 vs. 0.06, P < 0.01), and vascular CL (0.14 vs. 0.03 vs. 0.15, P < 0.01) among the three groups. Posterior wall disruption, pathologic fracture, and the number of treated vertebral levels were the most commonly identified independent risk factors for general CL. Posterior wall disruption was determined as a common significant risk factor for spinal canal CL.
This
review provides insights into the incidence and risk factors associated with CL in surgical procedures for spinal metastasis. Understanding these risk factors can contribute to the development of tailored strategies aimed at minimizing CL occurrence and optimizing surgical outcomes for patients undergoing spinal metastatic surgery.