不同药物联合椎体后凸成形术/经皮椎体成形术对骨质疏松性压缩骨折患者术后疼痛的影响：一项网状Meta分析
Effects of different drugs in combination with PKP/PVP on postoperative pain in patients with osteoporotic compression fractures: a network meta-analysis.
作者信息
Bai Yiguang, Chen Qiaoling, Wang RouMei, Huang Rui
机构信息
Department of Orthopaedics, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, China.
Department of Oncology, Nanchong Central Hospital, The Second Clinical Institute of North Sichuan Medical College, Nanchong, China.
出版信息
Front Surg. 2024 Jul 23;11:1349351. doi: 10.3389/fsurg.2024.1349351. eCollection 2024.
OBJECTIVE
This study was designed to evaluate the postoperative pain effect and clinical efficacy of different drugs combined with PKP or PVP in treating osteoporotic vertebral compression fractures (OVCFs) through a systematic review and network meta-analysis.
METHODS
We searched five electronic databases, namely, MEDLINE (PubMed), EMBASE, Web of Science, Google Scholar, and the Cochrane Central Register of Controlled Trials online, for the treatment of OVCFs through March 2023 with keywords zoledronic acid (ZOL), teriparatide (TPTD or PTH 1-34), and calcitonin (CT) combined with PKP/PVP. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were the primary outcomes of the network meta-analysis, and the secondary outcome was the diagnostic marker bone mineral density (BMD).
RESULTS
Eighteen studies involving 2,374 patients were included in this study. The network meta-analysis revealed that, in terms of reducing VAS scores, compared with PVP surgery alone, PVP combined with TPTD was most likely to be the treatment associated with the greatest pain relief [MD = -4.99, 95% CI = (-7.45, -2.52)]. In terms of reducing the ODI dysfunction score, compared with PKP combined with Cal, PKP combined with ZOL had the highest probability of being the best treatment option [MD = -9.11, 95% CI = (-14.27, -3.95)]. In terms of protecting against bone density loss, compared with PKP surgery alone, treatment with PKP combined with ZOL had the best effect [MD = 0.39, 95% CI = (0.13,0.65)].
CONCLUSIONS
Based on the network meta-analysis and SUCRA rankings, this study concluded that adding teriparatide has the advantage of reducing VAS pain scores compared with PVP alone and that adding zoledronate is a more effective treatment for reducing ODI scores compared with PKP combined with Cal and preserving BMD compared with PKP alone. However, additional high-quality studies are needed to verify our findings.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=358445, identifier CRD42022358445.
目的
本研究旨在通过系统评价和网络荟萃分析，评估不同药物联合椎体后凸成形术（PKP）或椎体成形术（PVP）治疗骨质疏松性椎体压缩骨折（OVCFs）的术后疼痛效果及临床疗效。
方法
我们检索了五个电子数据库，即MEDLINE（PubMed）、EMBASE、Web of Science、谷歌学术和Cochrane对照试验中心注册库在线版，检索截至2023年3月的关于唑来膦酸（ZOL）、特立帕肽（TPTD或PTH 1-34）和降钙素（CT）联合PKP/PVP治疗OVCFs的研究。视觉模拟量表（VAS）和Oswestry功能障碍指数（ODI）是网络荟萃分析的主要结局指标，次要结局指标是诊断标志物骨密度（BMD）。
结果
本研究纳入了18项涉及2374例患者的研究。网络荟萃分析显示，在降低VAS评分方面，与单纯PVP手术相比，PVP联合TPTD最有可能是与最大程度缓解疼痛相关的治疗方法[MD = -4.99，95%CI =（-7.45，-2.52）]。在降低ODI功能障碍评分方面，与PKP联合Cal相比，PKP联合ZOL最有可能是最佳治疗选择[MD = -9.11，95%CI =（-14.27，-3.95）]。在预防骨密度丢失方面，与单纯PKP手术相比，PKP联合ZOL治疗效果最佳[MD = 0.39，95%CI =（0.13，0.65）]。
结论
基于网络荟萃分析和累积排序曲线下面积（SUCRA）排名，本研究得出结论，与单纯PVP相比，添加特立帕肽在降低VAS疼痛评分方面具有优势，与PKP联合Cal相比，添加唑来膦酸在降低ODI评分方面是更有效的治疗方法，与单纯PKP相比，在保留BMD方面效果更佳。然而，需要更多高质量研究来验证我们的研究结果。
系统评价注册
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=358445，标识符CRD42022358445。
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