Orthopedics Department, Zhejiang Chinese Medicine University Affiliated Second Hospital, Hangzhou, China.
Ophthalmology Department, Zhejiang Chinese Medicine University Affiliated Second Hospital, Hangzhou, China.
World Neurosurg. 2022 Jan;157:75-87. doi: 10.1016/j.wneu.2021.09.131. Epub 2021 Oct 14.
This study was designed to help elucidate the benefits and advantages of vertebroplasty combined with zoledronic acid (ZOL) versus vertebroplasty alone, to provide clinical recommendations for the treatment of osteoporotic vertebral compression fractures (OVCFs) considering the current best-available evidence.
We comprehensively searched PubMed, Embase, Web of Science, and the Cochrane Library and performed a systematic review and cumulative meta-analysis of all randomized controlled trials and retrospective comparative studies assessing these important indexes of 2 methods using Review Manager 5.4.
Four randomized controlled trials and 4 retrospective studies including 2335 cases were identified. Vertebroplasty combined with ZOL was associated with benefits from decreased pain (weighted mean difference [WMD] -0.43; 95% confidence interval [CI] -0.59 to -0.27; P < 0.05), increased function (WMD -4.94; 95% CI -6.13 to -3.75; P < 0.05), increased BMD of the vertebral body(WMD 0.85; 95% CI 0.30-1.40; P < 0.05) and of the proximal femoral neck (WMD 0.14; 95% CI 0.08-0.21; P < 0.05), fewer markers of bone metabolism (N-terminal molecular fragment: WMD -4.82; 95% CI -6.08 to -3.55; P < 0.05; procollagen type I N-terminal propeptide: WMD -17.31; 95% CI -18.04 to -16.58; P < 0.05; beta collagen degradation product: WMD -0.27; 95% CI -0.35 to -0.19; P < 0.05), and lower rate of refracture (1.54% and 12.6%; odds ratio 0.17; 95% CI 0.08-0.36; P < 0.05). Patients in the vertebroplasty combined with ZOL group had greater vertebral body height (WMD 2.17; 95% CI 0.72-3.62; P < 0.05) than in the vertebroplasty group, but no differences on Cobb angle were observed (WMD -1.18; 95% CI -2.47 to 0.10; P > 0.05).
Vertebroplasty combined with ZOL was superior to vertebroplasty alone in terms of BMD, bone metabolism makers, refracture rate, pain and function.
本研究旨在阐明经皮椎体成形术（PVP）联合唑来膦酸（ZOL）与单纯 PVP 相比的优势，为考虑到现有最佳证据的骨质疏松性椎体压缩性骨折（OVCF）的治疗提供临床建议。
我们全面检索了 PubMed、Embase、Web of Science 和 Cochrane 图书馆，并使用 Review Manager 5.4 对所有评估这两种方法的重要指标的随机对照试验和回顾性比较研究进行了系统评价和累积荟萃分析。
共纳入了 4 项随机对照试验和 4 项回顾性研究，共计 2335 例患者。与单纯 PVP 相比，PVP 联合 ZOL 可降低疼痛（加权均数差 [WMD] -0.43；95%置信区间 [CI] -0.59 至 -0.27；P < 0.05）、改善功能（WMD -4.94；95% CI -6.13 至 -3.75；P < 0.05）、增加椎体（WMD 0.85；95% CI 0.30 至 1.40；P < 0.05）和股骨颈近端（WMD 0.14；95% CI 0.08 至 0.21；P < 0.05）的骨密度、减少骨代谢标志物（N 端分子片段：WMD -4.82；95% CI -6.08 至 -3.55；P < 0.05；I 型前胶原 N 端前肽：WMD -17.31；95% CI -18.04 至 -16.58；P < 0.05；β胶原降解产物：WMD -0.27；95% CI -0.35 至 -0.19；P < 0.05）、降低再骨折率（1.54%和 12.6%；比值比 0.17；95% CI 0.08 至 0.36；P < 0.05）。与单纯 PVP 组相比，PVP 联合 ZOL 组的椎体高度更大（WMD 2.17；95% CI 0.72 至 3.62；P < 0.05），但 Cobb 角无差异（WMD -1.18；95% CI -2.47 至 0.10；P > 0.05）。
与单纯 PVP 相比，PVP 联合 ZOL 在骨密度、骨代谢标志物、再骨折率、疼痛和功能方面更具优势。
