H. Lee Moffitt Cancer Center & Research Institute, Neurooncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA ; General Oncological Hospital "Agioi Anargyroi", 14564 Athens, Greece.
H. Lee Moffitt Cancer Center & Research Institute, Neurooncology Program and Department of Neurosurgery and Orthopaedics, University of South Florida College of Medicine, 12902 Magnolia Drive, Tampa, FL 33647, USA.
Biomed Res Int. 2014;2014:925683. doi: 10.1155/2014/925683. Epub 2014 Jan 19.
While evidence supports the efficacy of vertebral augmentation (kyphoplasty and vertebroplasty) for the treatment of osteoporotic fractures, randomized trials disputed the value of vertebroplasty. The aim of this analysis is to determine the subset of patients that may not benefit from surgical intervention and find the optimal intervention time.
27 prospective multiple-arm studies with cohorts of more than 20 patients were included in this meta-analysis. We hereby report the results from the metaregression and subset analysis of those trials reporting on treatment of osteoporotic fractures with kyphoplasty and/or vertebroplasty.
Early intervention (first 7 weeks after fracture) yielded more pain relief. However, spontaneous recovery was encountered in hyperacute fractures (less than 2 weeks old). Patients suffering from thoracic fractures or severely deformed vertebrae tended to report inferior results. We also attempted to formulate a treatment algorithm.
Intervention in the hyperacute period should not be pursued, while augmentation after 7 weeks yields less consistent results. In cases of thoracic fractures and significant vertebral collapse, surgeons or interventional radiologists may resort earlier to operation and be less conservative, although those parameters need to be addressed in future randomized trials.
虽然有证据支持椎体增强术（后凸成形术和椎体成形术）治疗骨质疏松性骨折的疗效，但随机试验对椎体成形术的价值存在争议。本分析的目的是确定可能无法从手术干预中获益的患者亚组，并找到最佳干预时间。
本荟萃分析纳入了 27 项前瞻性多臂研究，每个研究的队列均超过 20 例患者。在此，我们报告了那些报告使用后凸成形术和/或椎体成形术治疗骨质疏松性骨折的试验的荟萃回归和亚组分析结果。
早期干预（骨折后 7 周内）可获得更多的疼痛缓解。然而，在超急性期骨折（不到 2 周龄）中会出现自发恢复。胸腰椎骨折或严重变形的患者往往报告结果较差。我们还尝试制定了一个治疗算法。
不应在超急性期进行干预，而在 7 周后进行增强则效果不那么稳定。对于胸腰椎骨折和明显的椎体塌陷，外科医生或介入放射科医生可能更早地进行手术，而不是采用保守治疗，尽管这些参数需要在未来的随机试验中加以解决。
