Zhang Zitao, Fan Jin, Ding Qingfeng, Wu Minjie, Yin Guoyong
Department of Spine Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Spinal Disord Tech. 2013 Jun;26(4):E150-7. doi: 10.1097/BSD.0b013e31827412a5.
Literature review and meta-analysis.
To perform a systematic review and meta-analysis of risk factors for new osteoporotic vertebral compression fracture (VCF) after vertebroplasty.
New osteoporotic VCF is one of the serious complications of vertebroplasty, and it is important to investigate the risk factors for such VCFs. The risk factors for new VCFs reported so far remain controversial because of limited data and lack of uniform measurements and evaluation.
We searched the electronic database of PubMed for case-control studies about the risk of new osteoporotic VCFs after vertebroplasty.
A total of 116 studies were identified, of which 16 studies including 559 cases and 1736 controls met the inclusion criteria. The significant risk factors for new VCFs were low bone mineral density [BMD; standardized mean difference (SMD), -0.73; 95% confidence interval (CI), -1.26 to -0.20], low body mass index (BMI; SMD, -0.30; 95% CI, -0.51 to -0.10), and intradiscal cement leakage [odds ratio (OR), 2.13; 95% CI, 1.40-2.36]. The significant risk factors for new VCFs adjacent to the treated VCF were low BMD (SMD, -0.43; 95% CI, -0.76 to -0.09), low BMI (SMD, -0.52; 95% CI, -0.81 to -0.22), and intradiscal cement leakage (OR, 2.61; 95% CI, 1.63-4.17). Low BMD, low BMI, intradiscal cement leakage, cement volume, surgical approach, age, sex, and thoracolumbar junction fracture were all not significant risk factors for new VCFs away from the original VCF. Only one study reported dynamic characteristics as risk factors for new VCFs.
The results of this meta-analysis strongly suggested that patients with low BMD, low BMI, and intradiscal cement leakage were at high risk for new VCFs after vertebroplasty, and risk-reduction options should be considered for such patients.
文献综述与荟萃分析。
对椎体成形术后新发骨质疏松性椎体压缩骨折（VCF）的危险因素进行系统综述和荟萃分析。
新发骨质疏松性VCF是椎体成形术的严重并发症之一，研究此类VCF的危险因素很重要。由于数据有限以及缺乏统一的测量和评估方法，目前报道的新发VCF的危险因素仍存在争议。
我们在PubMed电子数据库中检索了关于椎体成形术后新发骨质疏松性VCF风险的病例对照研究。
共识别出116项研究，其中16项研究（包括559例病例和1736例对照）符合纳入标准。新发VCF的显著危险因素为低骨密度[BMD；标准化均数差（SMD），-0.73；95%置信区间（CI），-1.26至-0.20]、低体重指数（BMI；SMD，-0.30；95%CI，-0.51至-0.10）以及椎间盘内骨水泥渗漏[比值比（OR），2.13；95%CI，1.40 - 2.36]。与治疗的VCF相邻的新发VCF的显著危险因素为低BMD（SMD，-0.43；95%CI，-0.76至-0.09）、低BMI（SMD，-0.52；95%CI，-0.81至-0.22）以及椎间盘内骨水泥渗漏（OR，2.61；95%CI，1.63 - 4.17）。低BMD、低BMI、椎间盘内骨水泥渗漏、骨水泥体积、手术方式、年龄、性别以及胸腰段交界骨折均不是远离原VCF的新发VCF的显著危险因素。仅有一项研究报道动态特征为新发VCF的危险因素。
这项荟萃分析的结果强烈表明，BMD低、BMI低以及存在椎间盘内骨水泥渗漏的患者在椎体成形术后发生新发VCF的风险较高，对此类患者应考虑采取降低风险的措施。
