Department of Orthopedics, Beijing Friendship Hospital Capital Medical University (Capital Medical University Second Clinical Medical University), Xicheng District, Beijing, China.
Eur Rev Med Pharmacol Sci. 2021 Aug;25(16):5176-5188. doi: 10.26355/eurrev_202108_26531.
This study aimed to investigate whether percutaneous vertebral augmentation (PVA) was associated with clinical and radiological subsequent adjacent fractures in patients with osteoporotic vertebral compression fractures.
The systematic review was performed following PRISMA guidelines. Data were retrieved from PubMed, EMBASE, Cochrane Library, Google Scholar, Web of Science, and ClinicalTrial.gov, from database inception to March 2020. Eligible studies were those that assessed subsequent adjacent fractures after PVA in comparison with conservative treatment (CT). The number of patients with adjacent secondary vertebral fractures was calculated, and the pooled risk ratio (RR) with its 95% confidence intervals (95% CI) was used. Moreover, heterogeneity, sensitivity, and publication bias analyses were performed.
Twenty-four studies were included finally. Moreover, 20/421 (4.75%) patients from the PVA group and 25/359 (6.96%) patients from the CT group had clinical subsequent adjacent fractures, and 46/440 (10.45%) patients from the PVA group and 36/444 (8.10%) patients from the CT group had radiological subsequent adjacent fractures. Both had no significant difference between the two groups (RR = 0.67, 95% CI [0.38, 1.19], p = 0.17)/(RR = 1.13, 95% CI [0.75, 1.70], p = 0.576). However, the number of fractured vertebrae was higher in the PVA group than in the CT group (RR = 1.41, 95% CI [1.03, 1.93], p = 0.03). A sensitivity analysis did not identify specific trials that seriously deflected. No obvious publication bias was identified.
The systematic review revealed that PVA did not increase the incidence for subsequent adjacent fractures regardless of whether they were clinical or radiological fractures. However, PVA can increase the number of subsequent fractures at adjacent vertebral levels.
本研究旨在探讨经皮椎体强化术（PVA）是否与骨质疏松性椎体压缩骨折患者的临床和影像学后继相邻骨折有关。
本系统评价遵循 PRISMA 指南进行。从 PubMed、EMBASE、Cochrane 图书馆、谷歌学术、Web of Science 和 ClinicalTrials.gov 数据库中检索数据，检索时间从数据库建立到 2020 年 3 月。符合条件的研究是那些评估 PVA 后与保守治疗（CT）相比后继相邻骨折的研究。计算继发相邻椎体骨折的患者人数，并使用合并风险比（RR）及其 95%置信区间（95%CI）进行评估。此外，还进行了异质性、敏感性和发表偏倚分析。
最终纳入 24 项研究。此外，PVA 组 20/421（4.75%）例患者和 CT 组 25/359（6.96%）例患者发生临床后继相邻骨折，PVA 组 46/440（10.45%）例患者和 CT 组 36/444（8.10%）例患者发生影像学后继相邻骨折。两组之间无显著差异（RR=0.67，95%CI[0.38，1.19]，p=0.17）/（RR=1.13，95%CI[0.75，1.70]，p=0.576）。然而，PVA 组骨折椎体数高于 CT 组（RR=1.41，95%CI[1.03，1.93]，p=0.03）。敏感性分析未发现明显偏离的特定试验。未发现明显的发表偏倚。
系统评价显示，无论是否为临床或影像学骨折，PVA 均不会增加后继相邻骨折的发生率。然而，PVA 会增加相邻椎体水平的后续骨折数量。
