Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University (Capital Medical University Second Clinical Medical University), No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China.
Department of Emergency, Beijing Friendship Hospital, Capital Medical University (Capital Medical University Second Clinical Medical University), No. 95, Yong'an Road, Xicheng District, Beijing, 100050, China.
Eur Spine J. 2020 Oct;29(10):2576-2590. doi: 10.1007/s00586-020-06560-y. Epub 2020 Aug 10.
This study aimed to identify all relevant randomized controlled trials (RCT) and prospective non-RCTs to further investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent fractures on unoperated levels.
We systematically searched PubMed, EMBASE, Cochrane library, Google Scholar, web of science, and ClinicalTrial.gov from the establishment of the database to January 2020. All eligible studies comparing subsequent fractures after PVA with those after conservative treatment (CT) were incorporated. The pooled risk ratio (RR) with its 95% confidence intervals (95% CIs) was used. Heterogeneity, sensitivity, and publication bias analyses were performed.
In all, 32 studies were included in the study: 82/512 patients (16.02%) and 58/433 patients (13.39%) had clinical subsequent fractures in the PVA group and CT group, respectively. No significant differences were observed between the two groups [RR = 1.22, 95% CI 0.70-2.12, P = 0.49]. Further, 175/837 patients (20.91%) in the PVA group and 160/828 patients (19.32%) in the CT group had radiological subsequent fractures. No significant difference was observed between groups [RR = 0.91, 95% CI 0.71-2.12, P = 1.16]. Further, no statistical difference was observed on subgroup analysis between RCTs and non-RCTs or PVP and PKP.
Our systematic review revealed that subsequent fractures on unoperated levels were not associated with PVA, regardless of whether they were clinical or radiological subsequent fractures.
本研究旨在确定所有相关的随机对照试验（RCT）和前瞻性非随机对照试验，以进一步探讨经皮椎体强化术（PVA）是否与未手术水平的临床和影像学后续骨折有关。
我们系统地检索了 PubMed、EMBASE、Cochrane 图书馆、Google Scholar、Web of Science 和 ClinicalTrials.gov，从数据库建立到 2020 年 1 月。所有符合条件的研究均比较了 PVA 后与保守治疗（CT）后未手术水平的后续骨折。使用合并的风险比（RR）及其 95%置信区间（95%CI）。进行了异质性、敏感性和发表偏倚分析。
共有 32 项研究纳入本研究：PVA 组和 CT 组分别有 82/512 例（16.02%）和 58/433 例（13.39%）患者发生临床后续骨折，两组间无显著差异[RR=1.22，95%CI 0.70-2.12，P=0.49]。进一步，PVA 组 175/837 例（20.91%）和 CT 组 160/828 例（19.32%）患者发生影像学后续骨折，两组间无显著差异[RR=0.91，95%CI 0.71-2.12，P=1.16]。进一步，RCT 和非 RCT 或 PVP 和 PKP 亚组分析均未见统计学差异。
本系统评价显示，未手术水平的后续骨折与 PVA 无关，无论是临床还是影像学后续骨折。
