Department of Orthopaedics, Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China.
Orthop Surg. 2023 Oct;15(10):2492-2504. doi: 10.1111/os.13800. Epub 2023 Jul 27.
This systematic review and meta-analysis is aimed to provide higher quality evidence regarding the efficacy and safety between PCVP and PVP/KP in OVCFs. We searched the Cochrane Library, PubMed, Web of Science, and Embase databases for all randomized controlled trials (RCTs) and observational studies (cohort or case-control studies) that compare PCVP to PVP/KP for OVCFs. The Cochrane Collaboration's Risk of Bias Tool and Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the RCTs and non-RCTs, respectively. Meta-analysis was performed using RevMan 5.4 software. A total of seven articles consisting of 562 patients with 593 diseased vertebral bodies were included. Statistically significant differences were found in the postoperative visual analog scale (VAS) at 1 day (MD = -0.11; 95% CI: [-0.21 to -0.01], p = 0.03), but not at 3 months (MD = -0.21; 95% CI: [-0.41-0.00], p = 0.05) or 6 months (MD = 0.03; 95% CI: [-0.13-0.20], p = 0.70). There was no statistically significant difference in postoperative Oswestry disability index (ODI) at 1 day (MD = -0.28; 95% CI: [-0.62-0.05], p = 0.10), 3 months (MD = -1.52; 95% CI: [-3.11-0.07], p = 0.06), or 6 months (MD = 0.18; 95% CI: [-0.13-0.48], p = 0.25). Additionally, there were no statistically significant differences in Cobb angle (MD = 0.30; 95% CI: [-1.69-2.30], p = 0.77) or anterior vertebral body height (SMD = -0.01; 95% CI: [-0.26-0.23], p = 0.92) after surgery. Statistically significant differences were found in surgical time (MD = -8.60; 95% CI: [-13.75 to -3.45], p = 0.001), cement infusion volume (MD = -0.82; 95% CI: [-1.50 to -0.14], P = 0.02), and dose of fluoroscopy (SMD = -1.22; 95% CI: [-1.84 to -0.60], p = 0.0001) between curved and noncurved techniques, especially compared to bilateral PVP. Moreover, cement leakage showed statistically significant difference (OR = 0.40; 95% CI: [0.27-0.60], p < 0.0001). Compared with PVP/KP, PCVP is superior for pain relief at short-term follow-up. Additionally, PCVP has the advantages of significantly lower surgical time, radiation exposure, bone cement infusion volume, and cement leakage incidence compared to bilateral PVP, while no statistically significant difference is found when compared with unilateral PVP or PKP. In terms of quality of life and radiologic outcomes, the effects of PCVP and PVP/KP are not significantly different. Overall, this meta-analysis reveals that PCVP was an effective and safe therapy for patients with OVCFs.
本系统评价和荟萃分析旨在提供更高质量的证据，以比较 PCVP 和 PVP/KP 在 OVCFs 中的疗效和安全性。我们检索了 Cochrane 图书馆、PubMed、Web of Science 和 Embase 数据库，以获取所有比较 PCVP 与 PVP/KP 治疗 OVCFs 的随机对照试验（RCT）和观察性研究（队列或病例对照研究）。使用 Cochrane 协作组的偏倚风险工具和纽卡斯尔-渥太华量表（NOS）分别评估 RCT 和非 RCT 的质量。使用 RevMan 5.4 软件进行荟萃分析。共有 7 篇文章，包含 562 例 593 个患病椎体的患者。术后 1 天视觉模拟量表（VAS）（MD=-0.11；95%CI：[-0.21 至-0.01]，p=0.03）有统计学显著差异，但术后 3 个月（MD=-0.21；95%CI：[-0.41 至 0.00]，p=0.05）或 6 个月（MD=0.03；95%CI：[-0.13 至 0.20]，p=0.70）无统计学显著差异。术后 1 天（MD=-0.28；95%CI：[-0.62 至 0.05]，p=0.10）、3 个月（MD=-1.52；95%CI：[-3.11 至 0.07]，p=0.06）或 6 个月（MD=0.18；95%CI：[-0.13 至 0.48]，p=0.25），术后 Oswestry 残疾指数（ODI）无统计学显著差异。此外，Cobb 角（MD=0.30；95%CI：[-1.69 至 2.30]，p=0.77）或前椎体高度（SMD=-0.01；95%CI：[-0.26 至 0.23]，p=0.92）无统计学显著差异。手术时间（MD=-8.60；95%CI：[-13.75 至-3.45]，p=0.001）、骨水泥输注量（MD=-0.82；95%CI：[-1.50 至-0.14]，P=0.02）和透视剂量（SMD=-1.22；95%CI：[-1.84 至-0.60]，p=0.0001）在曲线和非曲线技术之间存在统计学显著差异，尤其是与双侧 PVP 相比。此外，水泥渗漏显示出统计学显著差异（OR=0.40；95%CI：[0.27 至 0.60]，p<0.0001）。与 PVP/KP 相比，PCVP 在短期随访时具有更好的缓解疼痛效果。此外，PCVP 具有明显更低的手术时间、辐射暴露、骨水泥输注量和水泥渗漏发生率，与双侧 PVP 相比，与单侧 PVP 或 PKP 相比，无统计学显著差异。在生活质量和影像学结果方面，PCVP 和 PVP/KP 的效果没有显著差异。总体而言，这项荟萃分析表明 PCVP 是治疗 OVCFs 的有效且安全的治疗方法。
