唑来膦酸联合经皮椎体后凸成形术预防和治疗骨质疏松性椎体压缩骨折的临床疗效：系统评价和荟萃分析。
Clinical efficacy of zoledronic acid combined with percutaneous kyphoplasty in the prevention and treatment of osteoporotic vertebral compression fracture: A systematic review and meta-analysis.
机构信息
Wangjing Hospital of CACMS, Beijing 100102.
Beijing Changping Hospital of Intergrated Chinese And Western Medicine, Beijing 102208.
出版信息
Medicine (Baltimore). 2021 Apr 2;100(13):e25215. doi: 10.1097/MD.0000000000025215.
OBJECTIVE
: The aim of this study is to investigate the clinical efficacy of zoledronic acid (ZOL) in the treatment and prevention of osteoporotic vertebral compression fractures (OVCF) after percutaneous kyphoplasty (PKP) for elderly patients.
METHODS
: The PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP, and Embase were investigated through June 2020. All randomized controlled trials (RCT) involving ZOL injections for OVCF were enrolled. Outcome indicators included the bone mineral density (BMD), Visual Analog Scale (VAS), recompression vertebral fracture (RVF), Oswestry Disability Index (ODI), and bone metabolism (Procollagen type I N-terminal propeptide [PINP] and βcross-linked C-telopeptide of type I collagen [β-CTX]), bone cement leakage. Review Manager 5.3 was used to analyze these indicators.
RESULTS
: In this study, (1).. Eight studies had met the eligibility criteria, a total of 578 participants were involved (285 and 293 in the experimental (ZOL) group and control [no ZOL] group, respectively). (2).. The BMD scores of patients with OVCF in the experimental group were significantly higher than that in the control group ( < .05). The VAS scores were significantly different between the 2 groups at the 6, 12 months follow-up ( < .05). After PKP operation, ZOL injections reduced the rate of RVF ( < .05). In the comparison of ODI scores, the experimental group improved compared with the control group ( < .05). Respectively, the bone metabolism of patients with OVCF after ZOL was better than that of patients in control group ( < .05).
CONCLUSION
: Zoledronic acid had a significant effect on the treatment and prevention of OVCF in elderly osteoporotic patients after PKP. Due to the limited quality and data, more high-quality studies are needed to confirm the results of this meta-analysis.
目的
本研究旨在探讨唑来膦酸（zoledronic acid，ZOL）在经皮椎体后凸成形术（percutaneous kyphoplasty，PKP）治疗老年骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fractures，OVCF）后的治疗和预防作用。
方法
检索 2020 年 6 月前PubMed、Cochrane Library、中国知网（China National Knowledge Infrastructure，CNKI）、万方、维普及 Embase 数据库，纳入所有应用唑来膦酸治疗 OVCF 的随机对照试验（randomized controlled trials，RCT）。观察指标包括骨密度（bone mineral density，BMD）、视觉模拟评分（visual analog scale，VAS）、再发椎体压缩性骨折（recompression vertebral fracture，RVF）、Oswestry 功能障碍指数（Oswestry Disability Index，ODI）、骨代谢[I 型前胶原氨基端前肽（Procollagen type I N-terminal propeptide，PINP）、I 型胶原交联 C 端肽（β-cross-linked C-telopeptide of type I collagen，β-CTX）]、骨水泥渗漏。采用 Review Manager 5.3 软件进行分析。
结果
（1）纳入 8 项研究，共 578 例患者，其中试验组（ZOL 组）285 例，对照组（无 ZOL 组）293 例。（2）ZOL 组 OVCF 患者 BMD 评分明显高于对照组（<0.05），2 组 VAS 评分在术后 6、12 个月时差异有统计学意义（<0.05），ZOL 组 RVF 发生率低于对照组（<0.05），ODI 评分改善优于对照组（<0.05），骨代谢优于对照组（<0.05）。
结论
唑来膦酸对 PKP 治疗老年骨质疏松性 OVCF 患者有显著的治疗和预防作用。但由于纳入研究质量及数据有限，还需更多高质量研究进一步验证本研究的结果。
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