Gu Chris N, Brinjikji Waleed, Evans Avery J, Murad Mohammad H, Kallmes David F
Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA.
J Neurointerv Surg. 2016 Jun;8(6):636-42. doi: 10.1136/neurintsurg-2015-011714. Epub 2015 May 11.
Many studies demonstrate that both kyphoplasty and vertebroplasty are superior to conservative therapy in the treatment of osteoporotic vertebral body compression fractures. We performed a systematic review and meta-analysis of studies comparing the outcomes of vertebroplasty and kyphoplasty, which included prospective non-randomized, retrospective comparative, and randomized studies.
We searched MEDLINE, EMBASE, and the Web of Science databases for studies of kyphoplasty versus vertebroplasty from 1 January 1990 to 30 November 2014 and compared the following outcomes: procedure characteristics, pain and disability improvement, complications and anatomic outcomes. A subgroup analysis was performed comparing pain outcomes based on the risk of bias.
29 studies enrolling 2838 patients (1384 kyphoplasty and 1454 vertebroplasty) were included. 16 prospective non-randomized studies, 10 retrospective comparative studies, and 3 randomized controlled studies were included. No significant differences were found in mean pain scores between the two groups postoperatively (2.9±1.5 kyphoplasty vs 2.9±1.7 vertebroplasty, p=0.39) and at 12 months (2.7±1.8 kyphoplasty vs 3.2±1.8 vertebroplasty, p=0.64). No significant differences were found in disability postoperatively (34.7±7.1 kyphoplasty group vs 36.3±7.8 vertebroplasty group, p=0.74) or at 12 months (28.3±16 kyphoplasty group vs 29.6±13.9 vertebroplasty group, p=0.70). Kyphoplasty was associated with lower odds of new fractures (p=0.06), less extraosseous cement leakage (p<0.01), and greater reduction in kyphotic angle (p<0.01).
No significant difference was found between vertebroplasty and kyphoplasty in short- and long-term pain and disability outcomes. Further studies are needed to better determine if any particular subgroups of patients would benefit more from vertebroplasty or kyphoplasty in the treatment of vertebral body compression fractures.
许多研究表明，在治疗骨质疏松性椎体压缩骨折方面，椎体后凸成形术和椎体成形术均优于保守治疗。我们对比较椎体成形术和椎体后凸成形术疗效的研究进行了系统评价和荟萃分析，这些研究包括前瞻性非随机研究、回顾性比较研究和随机研究。
我们检索了MEDLINE、EMBASE和科学引文索引数据库，以查找1990年1月1日至2014年11月30日期间关于椎体后凸成形术与椎体成形术的研究，并比较了以下结果：手术特征、疼痛和功能障碍改善情况、并发症及解剖学结果。基于偏倚风险对疼痛结果进行了亚组分析。
纳入了29项研究，共2838例患者（椎体后凸成形术1384例，椎体成形术1454例）。其中包括16项前瞻性非随机研究、10项回顾性比较研究和3项随机对照研究。两组术后平均疼痛评分（椎体后凸成形术2.9±1.5 vs椎体成形术2.9±1.7，p = 0.39）及术后12个月时（椎体后凸成形术2.7±1.8 vs椎体成形术3.2±1.8，p = 0.64）均无显著差异。术后（椎体后凸成形术组34.7±7.1 vs椎体成形术组36.3±7.8，p = 0.74）及术后12个月时（椎体后凸成形术组28.3±16 vs椎体成形术组29.6±13.9，p = 0.70）功能障碍方面也无显著差异。椎体后凸成形术与新发骨折几率较低（p = 0.06）、骨外骨水泥渗漏较少（p < 0.01）以及后凸角减小幅度更大（p < 0.01）相关。
椎体成形术和椎体后凸成形术在短期和长期的疼痛及功能障碍结果方面无显著差异。需要进一步研究以更好地确定在椎体压缩骨折治疗中，是否有特定亚组患者能从椎体成形术或椎体后凸成形术中获益更多。
