唑来膦酸联合经皮椎体后凸成形术/椎体成形术治疗骨质疏松性椎体压缩骨折的疗效：系统评价和荟萃分析。
Efficacy of zoledronic acid with percutaneous kyphoplasty/vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a systematic review and meta-analysis.
机构信息
Department of Orthopedics, Tianjin Fifth Central Hospital, Tianjin, China.
出版信息
Eur Rev Med Pharmacol Sci. 2020 Dec;24(23):12358-12367. doi: 10.26355/eurrev_202012_24030.
OBJECTIVE
The purpose of this study was to conduct a systematic review and meta-analysis analyzing the efficacy of zoledronic acid in improving outcomes with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) surgeries for osteoporotic vertebral compression fracture (OVCF).
MATERIALS AND METHODS
We electronically searched the databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar up to 15th September 2020. All types of studies assessing the use of zoledronic acid with PKP/PVP surgeries were included.
RESULTS
Seven studies were included. On meta-analysis of data from five studies reporting bone mineral density (BMD) as g/cm2, we found a statistically significant increase in BMD in the zoledronic group (MD: 0.14; 95% CI: 0.07, 0.21, I2=97%; p<0.001). On pooled analysis of two studies reporting T scores, a similar result in favour of the zoledronic acid group was noted (MD: 0.60; 95% CI: 0.23, 0.98, I2=76%; p=0.002). We also found a statistically significant reduction in pain scores (MD: -1.23; 95% CI: -1.59, -0.86, I2=97%; p<0.00001), ODI scores (MD: -9.54; 95% CI: -12.76, -6.31, I2=95%; p<0.00001) and serum type I procollagen peptide (CTX) levels (MD: -0.19; 95% CI: -0.25, -0.12, I2=98%; p<0.00001) with zoledronic acid as compared to control. Our analysis also found a significantly reduced risk of further vertebral fractures in patients receiving zoledronic acid as compared to control (RR: 0.17; 95% CI: 0.07, 0.39, I2=0%; p<0.00001).
CONCLUSIONS
Our review indicates that the use of once-yearly zoledronic acid in the peri-operative period of PVP/PKP procedures for patients with OVCF leads to significant improvement of BMD, reduced pain scores, better ODI scores, and reduced incidence of further vertebral fractures. Our results have clinical significance as it encourages the use of zoledronic acid for such patients for better clinical outcomes.
目的
本研究旨在进行系统评价和荟萃分析，以分析唑来膦酸在改善骨质疏松性椎体压缩性骨折（OVCF）经皮椎体后凸成形术（PVP）和经皮椎体成形术（PKP）手术疗效中的作用。
材料与方法
我们电子检索了 PubMed、Embase、ScienceDirect、CENTRAL 和 Google Scholar 数据库，检索时间截至 2020 年 9 月 15 日。纳入所有评估唑来膦酸联合 PKP/PVP 手术应用的研究。
结果
共纳入 7 项研究。对 5 项研究报告骨密度（BMD）为 g/cm2 的数据进行荟萃分析，我们发现唑来膦酸组的 BMD 有统计学显著增加（MD：0.14；95%CI：0.07，0.21，I2=97%；p<0.001）。对 2 项研究报告 T 评分进行汇总分析，也观察到唑来膦酸组有类似的结果（MD：0.60；95%CI：0.23，0.98，I2=76%；p=0.002）。我们还发现疼痛评分（MD：-1.23；95%CI：-1.59，-0.86，I2=97%；p<0.00001）、ODI 评分（MD：-9.54；95%CI：-12.76，-6.31，I2=95%；p<0.00001）和血清 I 型前胶原肽（CTX）水平（MD：-0.19；95%CI：-0.25，-0.12，I2=98%；p<0.00001）也有统计学显著降低，与对照组相比，唑来膦酸治疗组降低。我们的分析还发现，与对照组相比，接受唑来膦酸治疗的患者进一步发生椎体骨折的风险显著降低（RR：0.17；95%CI：0.07，0.39，I2=0%；p<0.00001）。
结论
我们的综述表明，在 OVCF 患者 PVP/PKP 手术围手术期使用每年一次的唑来膦酸可显著改善 BMD，减轻疼痛评分，改善 ODI 评分，并降低进一步椎体骨折的发生率。我们的研究结果具有临床意义，因为它鼓励此类患者使用唑来膦酸以获得更好的临床结果。
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