Zhao Song, Xu Chang-Yan, Zhu Ao-Ran, Ye Long, Lv Long-Long, Chen Long, Huang Qi, Niu Feng
Department of Spine Surgery Medical Record Department, The First Hospital of Jilin University, Changchun, Jilin, China.
Medicine (Baltimore). 2017 Jun;96(26):e7328. doi: 10.1097/MD.0000000000007328.
Osteoporotic vertebral compression fractures (OVCFs) constitute an age-related health problem that affects approximately 200 million people worldwide. Currently, various treatments are performed with the goal of reducing pain, stabilizing the vertebrate, and restoring mobility. In this study, we aimed to assess the efficacy and safety of vertebroplasty (VP), kyphoplasty (KP), and conservative treatment (CT) for the treatment of OVCFs.
We performed a network meta-analysis. PubMed and Embase databases were searched to identify randomized controlled trials (RCTs) that contained at least one of the following outcomes: visual analog scale (VAS), Roland-Morris Disability Questionnaire (RDQ), European Quality of Life-5 Dimensions (EQ-5D), and new fractures. Odds ratios with 95% confidence intervals (CIs) were used to calculate the risk of new fractures, and mean differences (MDs) with 95% CIs were utilized to express RDQ, EQ-5D, and VAS outcomes.
Sixteen RCTs with 2046 participants were included in this meta-analysis. Compared with CT, patients treated with VP had improved pain relief, daily function, and quality of life; however, no significant differences were found between VP and KP for these 3 outcomes. All treatment options were associated with comparable risk of new fractures. When the rank probability was assessed to distinguish subtle differences between the treatments, VP was the most effective treatment for pain relief, followed by KP and CT; conversely, KP was the most effective in improving daily function and quality of life and decreasing the incidence of new fractures, followed by VP and CT.
VP might be the best option when pain relief is the principle aim of therapy, but KP was associated with the lowest risk of new fractures and might offer better outcomes in terms of daily function and quality of life.
骨质疏松性椎体压缩骨折（OVCFs）是一个与年龄相关的健康问题，全球约有2亿人受其影响。目前，人们采取了各种治疗方法，旨在减轻疼痛、稳定椎体并恢复活动能力。在本研究中，我们旨在评估椎体成形术（VP）、后凸成形术（KP）和保守治疗（CT）治疗OVCFs的疗效和安全性。
我们进行了一项网状荟萃分析。检索了PubMed和Embase数据库，以识别至少包含以下一项结果的随机对照试验（RCTs）：视觉模拟量表（VAS）、罗兰-莫里斯残疾问卷（RDQ）、欧洲五维健康量表（EQ-5D）和新发骨折。采用95%置信区间（CIs）的比值比来计算新发骨折的风险，并使用95% CIs的均值差（MDs）来表示RDQ、EQ-5D和VAS结果。
本荟萃分析纳入了16项随机对照试验，共2046名参与者。与保守治疗相比，接受椎体成形术治疗的患者疼痛缓解、日常功能和生活质量均有所改善；然而，在这三项结果上，椎体成形术和后凸成形术之间未发现显著差异。所有治疗方案发生新发骨折的风险相当。当评估排序概率以区分治疗之间的细微差异时，椎体成形术是缓解疼痛最有效的治疗方法，其次是后凸成形术和保守治疗；相反，后凸成形术在改善日常功能和生活质量以及降低新发骨折发生率方面最有效，其次是椎体成形术和保守治疗。
当治疗的主要目标是缓解疼痛时，椎体成形术可能是最佳选择，但后凸成形术新发骨折的风险最低，在日常功能和生活质量方面可能会有更好的结果。
