Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China.
Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China.
World Neurosurg. 2023 Jul;175:47-56. doi: 10.1016/j.wneu.2023.03.114. Epub 2023 Apr 11.
Hidden blood loss (HBL), as a perioperative complication of percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP), affects the quality of life of older adults with poor health status, but it is often ignored by clinical surgeons. The purpose of this study was to discuss the risk factors for perioperative HBL through meta-analysis.
We systematically searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, Google Scholar, Chinese National Knowledge Infrastructure, and Wan Fang from establishment of the database to September 2022. All eligible studies regarding risk factors for HBL after PVP or PKP were included. Heterogeneity was assessed using the χ test and I statistic percentages. If I >50% or P < 0.1, the random-effect model was used; otherwise, the fixed-effect model was used. Data were analyzed with Revman 5.4 and Stata 16.0.
Eleven studies involving 1506 patients were included and the average HBL of PKP and PVP was 278.57 mL and 276.12mL. The results showed that bone cement leakage (P < 0.0001), thoracic vertebra (P < 0.00001), bilateral surgical approach (P = 0.0008), ≥2 fracture segments (P < 0.00001), vertebral body height loss rate (≥1/3) (P < 0.00001), and vertebral body height restoration rate (≥1/3) (P < 0.00001) were risk factors for increased HBL. Diabetes (P = 0.12) and hypertension (P = 0.52) were not significantly associated with HBL.
The findings of this meta-analysis suggested that fracture level, surgical approach, number of fracture levels, cement leakage, vertebral height loss and restoration rate were significant risk factors for HBL, which had certain guiding significance for clinical surgeons to take reasonable measures to deal with this complication.
隐性失血（HBL）是经皮椎体成形术（PVP）或经皮椎体后凸成形术（PKP）围手术期的并发症，会影响健康状况较差的老年患者的生活质量，但常被临床医生忽视。本研究旨在通过荟萃分析探讨 PVP 或 PKP 后 HBL 的相关危险因素。
我们系统检索了 PubMed、Embase、Cochrane 图书馆、Web of Science、Scopus、Google Scholar、中国知网和万方数据库，从数据库建立到 2022 年 9 月。所有关于 PVP 或 PKP 后 HBL 危险因素的研究均被纳入。使用 χ 检验和 I ² 百分比评估异质性。如果 I ² >50%或 P < 0.1，则使用随机效应模型；否则，使用固定效应模型。使用 Revman 5.4 和 Stata 16.0 进行数据分析。
纳入 11 项研究共 1506 例患者，PKP 和 PVP 的平均 HBL 分别为 278.57 毫升和 276.12 毫升。结果表明，骨水泥渗漏（P < 0.0001）、胸椎（P < 0.00001）、双侧手术入路（P = 0.0008）、≥2 个骨折节段（P < 0.00001）、椎体高度丢失率（≥1/3）（P < 0.00001）和椎体高度恢复率（≥1/3）（P < 0.00001）是增加 HBL 的危险因素。糖尿病（P = 0.12）和高血压（P = 0.52）与 HBL 无显著相关性。
本荟萃分析结果表明，骨折节段、手术入路、骨折节段数量、骨水泥渗漏、椎体高度丢失和恢复率是 HBL 的显著危险因素，对临床医生采取合理措施处理该并发症具有一定的指导意义。
