椎体强化术综述：有效性的最新荟萃分析
Review of Vertebral Augmentation: An Updated Meta-analysis of the Effectiveness.
作者信息
Beall Douglas, Lorio Morgan P, Yun B Min, Runa Maria J, Ong Kevin L, Warner Christopher B
机构信息
Clinical Radiology of Oklahoma, Edmond, Oklahoma.
Hughston Clinic Orthopaedics-Centennial, Nashville, Tennessee.
出版信息
Int J Spine Surg. 2018 Aug 15;12(3):295-321. doi: 10.14444/5036. eCollection 2018 Jun.
BACKGROUND
To update vertebral augmentation literature by comparing outcomes between vertebroplasty (VP), balloon kyphoplasty (BKP), vertebral augmentation with implant (VAI), and nonsurgical management (NSM) for treating vertebral compression fractures (VCFs).
METHODS
A PubMed literature search was conducted with keywords , , , and for English-language articles from February 1, 2011, to November 22, 2016. Among the results, 25 met the inclusion criteria for the meta-analysis. Inclusion criteria were prospective comparative studies for mid-/lower-thoracic and lumbar VCFs enrolling at least 20 patients. Exclusion criteria included studies that were single arm, systematic reviews and meta-analyses, traumatic nonosteoporotic or cancer-related fractures, lack of clinical outcomes, or non-Level I and non-Level II studies. Standardized mean difference between baseline and end point for each outcome was calculated, and treatment groups were pooled using random effects meta-analysis.
RESULTS
Visual analog scale pain reduction for BKP and VP was -4.05 and -3.88, respectively. VP was better than but not significantly different from NSM (-2.66), yet BKP showed significant improvement from both NSM and VAI (-2.77). The Oswestry Disability Index reduction for BKP showed a significant improvement over VAI ( < .001). There was no significant difference in changes between BKP and VP for anterior ( = .226) and posterior ( = .293) vertebral height restoration. There was no significant difference in subsequent fractures following BKP (32.7%; 95% confidence interval [CI]: 8.8%-56.6%) or VP (28.3%; 95% CI: 7.0%-49.7%) compared with NSM (15.9%; 95% CI: 5.2%-26.6%).
CONCLUSIONS/LEVEL OF EVIDENCE: Based on Level I and II studies, BKP had significantly better and VP tended to have better pain reduction compared with NSM. BKP tended to have better height restoration than VP. Additionally, BKP had significant improvements in pain reduction and disability score as compared with VAI.
CLINICAL RELEVANCE
This meta-analysis serves to further define and support the safety and efficacy of vertebral augmentation.
背景
通过比较椎体成形术（VP）、球囊扩张椎体后凸成形术（BKP）、带植入物椎体强化术（VAI）和非手术治疗（NSM）治疗椎体压缩骨折（VCF）的疗效，更新椎体强化相关文献。
方法
于2011年2月1日至2016年11月22日期间，在PubMed数据库中使用关键词 、 、 和 检索英文文献。结果中，25篇符合荟萃分析的纳入标准。纳入标准为针对中/下胸椎及腰椎VCF的前瞻性对照研究，纳入患者至少20例。排除标准包括单臂研究、系统评价和荟萃分析、创伤性非骨质疏松性或癌症相关骨折、缺乏临床结局数据的研究，以及非I级和非II级研究。计算每个结局从基线到终点的标准化均数差，并使用随机效应荟萃分析合并治疗组。
结果
BKP和VP的视觉模拟量表疼痛减轻程度分别为-4.05和-(-3.88)。VP优于NSM（-2.66），但差异无统计学意义，而BKP与NSM和VAI（-2.77）相比均有显著改善。BKP的Oswestry功能障碍指数降低程度与VAI相比有显著改善（ ＜0.001）。BKP和VP在前（ =0.226）后（ =0.293）椎体高度恢复方面的变化无显著差异。与NSM（15.9%；95%置信区间[CI]：5.2%-26.6%）相比，BKP（32.7%；95%CI：8.8%-56.6%）或VP（28.3%；95%CI：7.0%-49.7%）术后再次骨折的发生率无显著差异。
结论/证据级别：基于I级和II级研究，与NSM相比，BKP的疼痛减轻效果显著更好，VP的疼痛减轻效果倾向于更好。BKP的椎体高度恢复效果倾向于比VP更好。此外，与VAI相比，BKP在疼痛减轻和功能障碍评分方面有显著改善。
临床意义
本荟萃分析有助于进一步明确并支持椎体强化术的安全性和有效性。
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