经皮椎体成形术与非手术治疗骨质疏松性椎体压缩骨折临床效果的Meta分析(1)
[摘要] 目的 对比经皮椎体成形术(PVP)和非手术治疗骨质疏松性椎体压缩骨折(OVCFs)的临床效果。 方法 全面检索国内外关于OVCFs治疗的相关文献，按照纳入和排除标准筛选文献并提取数据，用Review Manager 5.0软件进行Meta分析。检索年限：2000年1月～2014年9月。 结果 共纳入6篇随机对照研究。Meta分析结果表明：与非手术治疗相比，PVP在术后的早期和长期均可以明显缓解疼痛(MD=-1.88，95%CI为-3.20～-0.57，P=0.005；MD=-1.39，95%CI为-2.10～-0.69，P=0.001)，但是在RDQ功能评分和EQ-5D生活质量评分方面差异无统计学意义(MD=-0.43，95%CI为-2.15～1.28，P=0.62；MD=0.11，95%CI为-0.77～0.30，P=0.23)，并且在新发椎体骨折率和邻近椎体骨折率方面差异亦无统计学意义(RR=1.22，95%CI为0.72～2.08，P=0.47；RR=2.07，95%CI为0.95～4.45，P=0.07)。 结论 对于骨质疏松椎体压缩骨折，经皮椎体成形术是一种安全有效的治疗方法，能取得不错的临床效果。
[关键词] 骨质疏松；椎体压缩骨折；经皮椎体成形术；非手术；Meta 分析
[中图分类号] R687.3 [文献标识码] A [文章编号] 1674-4721(2015)05(c)-0011-06
[Abstract] Objective To compare the clinical effect of percutaneous vertebroplasty (PVP) and non-surgery in the treatment of osteoporosis vertebral compressed fractures (OVCFs). Methods The relevant literatures on treating OCVFs both home and abroad were searched.These literatures were sieved and data were collected based on inclusion and exclusion criteria.Software of Review Manager 5.0 was used for Meta-analysis.The fixed number of years of searching lasted from January 2000 to September 2014. Results There were 6 articles with randomized controlled trials (RCT) included.Meta-analysis indicated that in comparison with non-surgical therapy，PVP could greatly alleviate pain in an early periodand a long term (MD=-1.88，95%CI was from -3.20 to -0.57，P=0.005；MD=-1.39，95%CI was from -2.10 to -0.69，P=0.001).There was no statistical difference in RDQ functional score or EQ-5D living quality score (MD= -0.43，95%CI was from -2.15 to 1.28，P=0.62；MD=0.11，95%CI was from -0.77 to 0.30，P=0.23).Besides，differences of newly-occurred vertebral fracture rate and adjacent vertebral fracture rate did not display statistical significance，either (RR=1.22，95%CI was from 0.72 to 2.08，P=0.47；RR=2.07，95%CI was from 0.95 to 4.45，P=0.07). Conclusion In the treatment of OVCFs，PVP is a safe and effective therapeutic method and can obtain favorable clinical effect.
[Key words] Osteoporosis；Vertebral compressed fracture；Percutaneous vertebroplasty；Non-surgery；Meta-analysis
骨质疏松症(osteoporosis，OP)是一种由多种原因引起的全身性疾病，其特点是骨量减少、骨组织微结构破坏和骨骼脆性增加，从而使人体容易发生骨折[1]。在临床工作中，骨质疏松性椎体压缩骨折(osteoporosis vertebral compressed fractures，OVCFs)是骨质疏松骨折的常见类型，常常引起严重的腰背部疼痛、脊柱后凸畸形、肌肉萎缩、身高降低，甚至危及生命[2]。目前，对骨质疏松性椎体压缩骨折的非手术治疗方式包括卧床休息、镇痛治疗及佩戴支具以限制身体过度前倾，这经常会导致患者持续疼痛不缓解，死亡率高等，进而严重影响患者的生活质量[3]。近年来，因PVP能够迅速止痛，明显提高患者的生活质量，具有手术侵入性小、创伤小、时间短、稳定椎体等特点，被广泛应用于治疗OVCFs[4]。然而，有研究者对PVP治疗骨质疏松性椎体压缩骨折的有效性和安全性提出了质疑，即认为其对比保守治疗[5]并无明显优势，且可能增加新椎体和邻近椎体骨折发生率[6]。因此，本研究通过Meta分析的方法分析PVP和非手术治疗OVCFs的有效性和安全性，进而比较两者的临床疗效，为OVCFs的临床治疗方法的选择提供循证医学依据。 (戴楠)
[关键词] 骨质疏松；椎体压缩骨折；经皮椎体成形术；非手术；Meta 分析
[中图分类号] R687.3 [文献标识码] A [文章编号] 1674-4721(2015)05(c)-0011-06
[Abstract] Objective To compare the clinical effect of percutaneous vertebroplasty (PVP) and non-surgery in the treatment of osteoporosis vertebral compressed fractures (OVCFs). Methods The relevant literatures on treating OCVFs both home and abroad were searched.These literatures were sieved and data were collected based on inclusion and exclusion criteria.Software of Review Manager 5.0 was used for Meta-analysis.The fixed number of years of searching lasted from January 2000 to September 2014. Results There were 6 articles with randomized controlled trials (RCT) included.Meta-analysis indicated that in comparison with non-surgical therapy，PVP could greatly alleviate pain in an early periodand a long term (MD=-1.88，95%CI was from -3.20 to -0.57，P=0.005；MD=-1.39，95%CI was from -2.10 to -0.69，P=0.001).There was no statistical difference in RDQ functional score or EQ-5D living quality score (MD= -0.43，95%CI was from -2.15 to 1.28，P=0.62；MD=0.11，95%CI was from -0.77 to 0.30，P=0.23).Besides，differences of newly-occurred vertebral fracture rate and adjacent vertebral fracture rate did not display statistical significance，either (RR=1.22，95%CI was from 0.72 to 2.08，P=0.47；RR=2.07，95%CI was from 0.95 to 4.45，P=0.07). Conclusion In the treatment of OVCFs，PVP is a safe and effective therapeutic method and can obtain favorable clinical effect.
[Key words] Osteoporosis；Vertebral compressed fracture；Percutaneous vertebroplasty；Non-surgery；Meta-analysis
骨质疏松症(osteoporosis，OP)是一种由多种原因引起的全身性疾病，其特点是骨量减少、骨组织微结构破坏和骨骼脆性增加，从而使人体容易发生骨折[1]。在临床工作中，骨质疏松性椎体压缩骨折(osteoporosis vertebral compressed fractures，OVCFs)是骨质疏松骨折的常见类型，常常引起严重的腰背部疼痛、脊柱后凸畸形、肌肉萎缩、身高降低，甚至危及生命[2]。目前，对骨质疏松性椎体压缩骨折的非手术治疗方式包括卧床休息、镇痛治疗及佩戴支具以限制身体过度前倾，这经常会导致患者持续疼痛不缓解，死亡率高等，进而严重影响患者的生活质量[3]。近年来，因PVP能够迅速止痛，明显提高患者的生活质量，具有手术侵入性小、创伤小、时间短、稳定椎体等特点，被广泛应用于治疗OVCFs[4]。然而，有研究者对PVP治疗骨质疏松性椎体压缩骨折的有效性和安全性提出了质疑，即认为其对比保守治疗[5]并无明显优势，且可能增加新椎体和邻近椎体骨折发生率[6]。因此，本研究通过Meta分析的方法分析PVP和非手术治疗OVCFs的有效性和安全性，进而比较两者的临床疗效，为OVCFs的临床治疗方法的选择提供循证医学依据。 (戴楠)