Department of Orthopedic Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, China Institute of Spine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Pain Physician. 2013 Sep-Oct;16(5):455-64.
Osteoporotic vertebral compression fractures (OVCFs) are the most common osteoporotic fractures. Pain is the main symptom. Percutaneous vertebroplasty (PVP) is a therapeutic procedure performed to reduce pain in vertebral compression fractures. Numerous case series and several small, non-blinded, non-randomized controlled studies have suggested that vertebroplasty is an effective means of relieving pain from osteoporotic fractures. However, a recent pooled analysis from 2 multicenter randomized controlled trials concluded that the improvement in pain afforded by PVP was similar to placebo.
To compare the amount of pain reduction measured using the visual analog scale when OVCF is treated with vertebroplasty or conservatively, and assess the clinical utility of PVP.
A meta-analysis and systematic review of randomized controlled trials was performed comparing pain reduction following vertebroplasty and conservative treatment.
There were few data sources from which to extract abstracted data or published studies. There were only 5 randomized controlled trials that met our criteria. The conservative treatments used as comparators in these trials were different.
A search of MEDLINE from January 1980 to July 2012 using PubMed, the Cochrane Database of Systematic Reviews and Controlled Trials, CINAHL, and EMBASE. Relevant reports were examined by 2 independent reviewers and the references from these reports were searched for additional trials, using the criteria established in the QUOROM statement.
Pooled results from 5 randomized controlled trials are shown. There was no difference in pain relief in the PVP group at 2 weeks and one month when compared with the conservatively managed group. Pain relief in the PVP group was greater than that of the conservative group at 3 months, 6 months, and 12 months. However, after subgroup analysis, pain scores were similar between the PVP group and the sham injection group from 2 weeks to 6 months. Compared with non-operative therapy, PVP reduced pain at all times studied.
PVP has some value for relieving pain; however, the possibility of a placebo effect should be considered. PVP has gained acceptance as a complementary treatment when conservative management has failed before its benefits have been fully understood. More large scale, double blinded, controlled trials are necessary in order to quantify the pain relief afforded by PVP more precisely.
骨质疏松性椎体压缩性骨折（OVCFs）是最常见的骨质疏松性骨折。疼痛是主要症状。经皮椎体成形术（PVP）是一种治疗方法，用于减轻椎体压缩性骨折的疼痛。大量病例系列和几项小型、非盲、非随机对照研究表明，椎体成形术是缓解骨质疏松性骨折疼痛的有效方法。然而，最近来自 2 项多中心随机对照试验的汇总分析得出结论，PVP 缓解疼痛的效果与安慰剂相似。
比较 OVCF 经椎体成形术或保守治疗后使用视觉模拟量表测量的疼痛缓解量，并评估 PVP 的临床效用。
对比较椎体成形术后和保守治疗后疼痛缓解的随机对照试验进行荟萃分析和系统评价。
从中提取摘要数据或发表研究的数据源很少。符合我们标准的随机对照试验只有 5 项。这些试验中用作对照的保守治疗方法不同。
使用 MEDLINE 从 1980 年 1 月至 2012 年 7 月通过 PubMed、Cochrane 系统评价和对照试验数据库、CINAHL 和 EMBASE 进行搜索。由 2 位独立评审员检查相关报告，并使用 QUOROM 声明中确定的标准搜索这些报告的参考文献以寻找其他试验。
显示了 5 项随机对照试验的汇总结果。与保守治疗组相比，PVP 组在 2 周和 1 个月时的疼痛缓解无差异。PVP 组在 3 个月、6 个月和 12 个月时的疼痛缓解大于保守组。然而，在亚组分析后，从 2 周到 6 个月，PVP 组和假注射组的疼痛评分相似。与非手术治疗相比，PVP 在所有研究时间都减轻了疼痛。
PVP 在缓解疼痛方面具有一定价值；然而，应考虑到安慰剂效应的可能性。在充分了解保守治疗失败之前，PVP 已被接受为一种补充治疗方法。为了更精确地量化 PVP 带来的疼痛缓解，需要进行更多大规模、双盲、对照试验。
