Operating Room, Shanghai Sixth People's Hospital, Shanghai, China.
Department of Spine Surgery, Shanghai Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
Arch Orthop Trauma Surg. 2022 Oct;142(10):2435-2443. doi: 10.1007/s00402-021-03858-4. Epub 2021 Mar 13.
To investigate the clinical effectiveness of combination treatment of percutaneous kyphoplasty (PKP) and zoledronic acid (ZOL) in the treatment of osteoporotic vertebral compression fracture (OVCF).
We searched studies investigating the PKP combined with ZOL in the treatment of OVCF. We used a fixed-effects or random-effects model to analyze the bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), bone markers (N-MID, β-CTX, and P1NP) and adverse events, expressed as weight mean difference (WMD) and risk ratio (RR) with 95% confidence interval (95% CI).
We identified 5 cohort studies with a total of 440 patients. Compared with PKP alone, the combination treatment of PKP and ZOL significantly reduced the VAS score at 6 months (WMD = - 0.78, 95% CI - 1.42, - 0.14; P = 0.018), and 12 months (WMD = - 0.98, 95% CI - 1.46, - 0.51; P < 0.001). Moreover, the combination treatment also improved the BMD at 6 (WMD = 0.06, 95% CI 0.01, 0.11, P = 0.016) and 12 months (WMD = 0.20, 95% CI 0.03, 0.36, P = 0.018) after treatment. The ODI score in the combination group was significantly lower than in PKP group at 6, 12 and 24 months after treatment (at 6 months: WMD = - 9.25, 95% CI - 13.62, - 4.87 P < 0.001; at 12 months: WMD = - 9.21, 95% CI - 11.91, - 6.50, P < 0.001; at 24 months: WMD = - 7.26, 95% CI - 11.39, - 3.14, P = 0.001). The N-MID and P1NP values were found to be significantly lower in the combination group than the PKP group, but the β-CTX value was similar between the two groups. There was no significant difference in incidence of adverse events between the two groups, but more adjacent vertebral fractures and bone cement leakage occurred in PKP alone group.
In patients with OVCF, combination treatment of PKP and ZOL showed more effective than PKP alone in improving BMD and bone marker levels, relieving pain, as well as reducing the risk of new fractures. More large-scale RCTs are needed to verify our findings.
研究经皮椎体后凸成形术（PKP）联合唑来膦酸（ZOL）治疗骨质疏松性椎体压缩性骨折（OVCF）的临床疗效。
我们检索了 PKP 联合 ZOL 治疗 OVCF 的研究。我们使用固定效应或随机效应模型分析骨密度（BMD）、视觉模拟量表（VAS）、Oswestry 残疾指数（ODI）、骨标志物（N-MID、β-CTX 和 P1NP）和不良事件，用加权均数差（WMD）和风险比（RR）及 95%置信区间（95%CI）表示。
我们确定了 5 项队列研究，共纳入 440 例患者。与 PKP 单独治疗相比，PKP 联合 ZOL 治疗在 6 个月（WMD=-0.78，95%CI-1.42，-0.14；P=0.018）和 12 个月（WMD=-0.98，95%CI-1.46，-0.51；P<0.001）时 VAS 评分明显更低。此外，联合治疗还可改善治疗后 6 个月（WMD=0.06，95%CI 0.01，0.11，P=0.016）和 12 个月（WMD=0.20，95%CI 0.03，0.36，P=0.018）时的 BMD。治疗后 6、12 和 24 个月时，联合组的 ODI 评分均明显低于 PKP 组（6 个月：WMD=-9.25，95%CI-13.62，-4.87，P<0.001；12 个月：WMD=-9.21，95%CI-11.91，-6.50，P<0.001；24 个月：WMD=-7.26，95%CI-11.39，-3.14，P=0.001）。联合组的 N-MID 和 P1NP 值明显低于 PKP 组，而 β-CTX 值两组间相似。两组不良事件发生率无显著差异，但 PKP 单独组更易发生邻近椎体骨折和骨水泥渗漏。
对于 OVCF 患者，PKP 联合 ZOL 治疗在改善 BMD 和骨标志物水平、缓解疼痛、降低新发骨折风险方面优于 PKP 单独治疗。还需要更多的大规模 RCT 来验证我们的研究结果。
