Department of Orthopaedic Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Eur Spine J. 2020 Jul;29(7):1553-1572. doi: 10.1007/s00586-020-06391-x. Epub 2020 Apr 2.
A systematic review, to study treatment effects for osteoporotic vertebral fractures (OVFs) in the elderly including all available evidence from controlled trials on percutaneous cement augmentation.
Primary studies, published up to December, 2019, were searched in PubMed and the Cochrane Library. Selected were all prospective controlled studies including patients > 65 years of age and reporting on at least one main outcome. Main outcomes were pain, disability and quality of life (QOL) 1 day post-intervention and at 6 months postoperatively. Excluded were meta-analyses or reviews, retrospective or non-controlled studies, case studies, patients' groups with neoplastic and/or traumatic fractures and/or neurologically compromised patients.
Eighteen studies comprising 2165 patients (n = 1117 percutaneous cement augmentation, n = 800 conservative treatment (CT), n = 248 placebo) with a mean follow-up of up to 12 months were included. Pooled results showed significant pain relief in favor of percutaneous cement augmentation compared to CT, direct postoperative and at 6 months follow-up. At 6 months, a significant difference was observed for functional disability scores in favor of percutaneous cement augmentation. When comparing percutaneous cement augmentation to placebo, no significant differences were observed.
This review incorporates all current available evidence (RCTs and non-RCTs) on the efficacy of percutaneous cement augmentation in the treatment of OVFs in the elderly. Despite methodological heterogeneity of the included studies, this review shows overall significant sustained pain relief and superior functional effect in the short- and long term for percutaneous cement augmentation compared to conservative treatment. These slides can be retrieved under Electronic Supplementary Material.
系统回顾研究经皮骨水泥强化治疗老年骨质疏松性椎体骨折（OVF）的疗效，包括所有已发表的关于经皮骨水泥强化治疗的对照试验证据。
检索 PubMed 和 Cochrane 图书馆，搜索截止到 2019 年 12 月的所有原始研究。纳入所有前瞻性对照研究，纳入患者年龄均>65 岁，并报告至少一项主要结局。主要结局为干预后 1 天和术后 6 个月时的疼痛、残疾和生活质量（QOL）。排除标准为荟萃分析或综述、回顾性或非对照研究、病例研究、伴有肿瘤和/或创伤性骨折和/或神经功能受损的患者群体。
纳入 18 项研究，共 2165 例患者（n=1117 例经皮骨水泥强化治疗，n=800 例保守治疗，n=248 例安慰剂），平均随访时间最长达 12 个月。汇总结果显示，与保守治疗相比，经皮骨水泥强化治疗在直接术后和术后 6 个月时疼痛缓解更明显。在术后 6 个月时，经皮骨水泥强化治疗在功能残疾评分方面具有显著优势。与安慰剂相比，经皮骨水泥强化治疗无显著差异。
本综述纳入了目前所有关于经皮骨水泥强化治疗老年 OVF 的疗效的证据（RCT 和非 RCT）。尽管纳入研究的方法学存在异质性，但本综述显示，与保守治疗相比，经皮骨水泥强化治疗在短期和长期内总体上能显著持续缓解疼痛，改善功能。这些幻灯片可在电子补充材料中获取。
