检索并分析来自比较单侧与双侧PKP治疗OVCFs的英国随机对照试验的数据,结果表明,单侧PKP是治疗OVCFs的较好选择,这将为OVCFs的治疗提供可靠的临床依据。
目的:探讨单侧经皮椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩骨折(OVCFs)的优势。
方法:系统评估计划通过成功通过PROSPERO国际前瞻性系统评估注册,满足了所有计划要求(CRD42023422383)。研究人员搜索了2010年至2023年发表的比较单侧和双侧PKP治疗骨质疏松性椎体压缩骨折的英语随机对照试验的参考文献,并手动搜索了已知的主要和评论文章。该研究对所有纳入文献的数据进行了统计分析,主要包括手术时间,术后随访时间点的视觉疼痛评分(VAS)和Oswestry残疾指数(ODI),聚甲基丙烯酸甲酯(PMMA,骨水泥)注射剂量,水泥渗漏,辐射剂量,并改善后凸角。
结果:这项荟萃分析基于关键词搜索了2010年至2023年发表的416篇文章,18篇文章最终纳入本研究。森林地块的结果表明,单侧PKP手术时间,骨水泥用量,和患者的辐射剂量显着减少(分别为p<0.01,p<0.01和p<0.01),单侧和双侧PKP具有相当的水泥渗漏(p=0.49,95%CI=0.58-1.30),单侧和双侧PKP的后凸角度差异无统计学意义(p=0.42,95%CI=-2.29-0.96)。随访期间,单侧和双侧PKP之间的疼痛缓解没有显着差异(p=0.70,95%CI=-0.09-0.06),ODI也没有显着差异(p=0.27,95%CI=-0.35-1.24)。
结论:单侧PKP与双侧PKP的临床疗效无差异,但是单侧PKP的手术时间较短,水泥渗漏的发生率较低,较低的水泥用量,对病人和操作者的辐射剂量较低。对于OVCFs患者,单侧PKP是更好的选择。
Data from English randomized controlled trials comparing unilateral versus bilateral PKP for the treatment of OVCFs were retrieved and analyzed, and the results showed that unilateral PKP is a better choice for the treatment of patients with OVCFs, which will provide a reliable clinical rationale for the treatment of OVCFs.
OBJECTIVE: To investigate the advantages of unilateral percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures(OVCFs).
METHODS: The systematic evaluation program met all program requirements (CRD 42023422383) by successfully passing the PROSPERO International Prospective Systematic Evaluation Registry. Researchers searched the references of English-language randomized controlled trials comparing unilateral and bilateral PKP for the treatment of osteoporotic vertebral compression fractures published between 2010 and 2023 and manually searched for known primary and review articles. The study statistically analyzed data from all the included literature, which primarily included time to surgery, visual pain score(VAS) and Oswestry disability index(ODI) at postoperative follow-up time points, polymethylmethacrylate (PMMA, bone cement) injection dose, cement leakage, radiation dose, and improvement in kyphotic angle.
RESULTS: This meta-analysis searched 416 articles published from 2010 to 2023 based on keywords, and 18 articles were finally included in this study. The results of the forest plot showed that unilateral PKP operative time, amount of bone cement used, and radiation dose to the patient were significantly reduced (p < 0.01, p < 0.01, and p < 0.01, respectively), and unilateral and bilateral PKP had comparable cement leakage (p = 0.49, 95% CI = 0.58-1.30), and there was no significant difference in the kyphotic angle between unilateral and bilateral PKP (p = 0.42, 95% CI = - 2.29-0.96). During follow-up, there was no significant difference in pain relief between unilateral and bilateral PKP (p = 0.70, 95% CI = - 0.09-0.06), nor was there a significant difference in ODI (p = 0.27, 95% CI = - 0.35-1.24).
CONCLUSIONS: There is no difference in clinical efficacy between unilateral PKP and bilateral PKP, but unilateral PKP has a shorter operative time, a lower incidence of cement leakage, a lower amount of cement, and a lower radiation dose to the patient and operator. Unilateral PKP is a better option for patients with OVCFs.