椎體后凸成形術(shù)治療骨質(zhì)疏松導(dǎo)致的椎體骨折兩種手術(shù)入路的療效和并發(fā)癥分析

高飛 魏來福 章益群 涂必治 錢軍

摘?要：目的：通過Meta分析對治療骨質(zhì)疏松性椎體骨折中穿刺椎體后凸成形術(shù)的兩種術(shù)式的安全性和療效進(jìn)行分析評價，以便指導(dǎo)臨床手術(shù)方式選擇。方法：通過計算機(jī)檢索2021年1月之前大量數(shù)據(jù)庫。最終納入相關(guān)符合要求的文獻(xiàn)進(jìn)行研究。根據(jù)Cochrane手冊，所納入文獻(xiàn)質(zhì)量由2位評價員根據(jù)手冊內(nèi)容標(biāo)準(zhǔn)獨立進(jìn)行評價，統(tǒng)計分析上用RevMan?5.3軟件，以獲得分析結(jié)果。結(jié)果與結(jié)論：（1）最終11篇符合要求文獻(xiàn)被納入研究，患者一共有1209例，包括604例單側(cè)穿刺患者和605例的雙側(cè)穿刺患者;（2）Meta分析得出的結(jié)果顯示：醫(yī)生在操作時間、患者在術(shù)中接受X射線的時間、術(shù)中患者透視次數(shù)、術(shù)中骨水泥使用體積、術(shù)后骨水泥泄露發(fā)生人數(shù)上有明顯差異（P<0.01）;但術(shù)后隨訪的患者中，兩種入路在手術(shù)后VAS評分、恢復(fù)的椎體高度、后凸角、再次發(fā)生相鄰椎體骨折、ODI評分等方面從統(tǒng)計學(xué)上看無意義（P>0.05）。（3）結(jié)果表明：兩種手術(shù)入路術(shù)后效果大體一致，但與雙側(cè)穿刺相比，單側(cè)穿刺治療具有操作時間短，術(shù)中接受輻射少，術(shù)后并發(fā)癥少等優(yōu)點，因此單側(cè)入路應(yīng)作為治療骨質(zhì)疏松導(dǎo)致椎體壓縮骨折的標(biāo)準(zhǔn)入路。

關(guān)鍵詞：骨質(zhì)疏松性椎體壓縮性骨折;經(jīng)皮穿刺椎體后凸成形術(shù);椎體后凸成形術(shù);單側(cè)穿刺;單側(cè)入路;雙側(cè)穿刺;雙側(cè)入路;meta分析

Analysis?of?the?curative?effect?and?complications?of?two?surgical?approaches?for

the?treatment?of?vertebral?fractures?caused?by?osteoporosis

Gao?Fei?Wei?Laifu?Zhang?Yiqun?Tu?Bizhi?Qian?Jun*

First?Affiliated?Hospital?of?Anhui?Medical?University?AnhuiHefei?230022

Abstract：OBJECTIVE：Metaanalysis?is?used?to?analyze?and?evaluate?the?safety?and?efficacy?of?the?two?surgical?methods?of?percutaneous?kyphoplasty?in?the?treatment?of?vertebral?fractures?caused?by?osteoporosis?in?order?to?guide?the?choice?of?clinical?surgical?methods.METHODS：We?use?computers?to?search?a?large?number?of?databases?before?January?2021，and?then?proceed?to?the?next?step?of?screening?and?evaluation.According?to?the?Cochrane?Handbook，the?quality?of?the?included?literature?was?independently?evaluated?by?2?reviewers?according?to?the?manual?content?standards，and?RevMan?5.3?software?was?used?for?statistical?analysis?to?obtain?the?analysis?results.RESULTS?AND?CONCLUSION：（1）Finally，11?documents?that?meet?the?requirements?were?included?in?the?study.There?were?1209?patients，including?604?unilateral?puncture?patients?and?605?bilateral?puncture?patients;（2）The?results?of?the?Meta?analysis?show?that?there?are?significant?differences?in?the?doctor's?operation?time，the?patient's?intraoperative?Xray?time，the?number?of?intraoperative?patient?fluoroscopy，the?intraoperative?bone?cement?volume，and?the?number?of?postoperative?bone?cement?leaks（P?<0.01）;but?the?two?approaches?were?statistically?insignificant?in?VAS?scores，vertebral?body?height，kyphotic?angle，reoccurrence?of?adjacent?vertebral?fractures，ODI?scores?and?other?aspects?of?postoperative?followup?patients（P>0.05）.（3）The?results?show?that?the?postoperative?effects?of?the?two?surgical?approaches?are?roughly?the?same，but?compared?with?bilateral?puncture，unilateral?puncture?has?the?advantages?of?shorter?operation?time，less?intraoperative?radiation，and?fewer?postoperative?complications.Therefore，the?unilateral?approach?should?be?used?as?the?standard?approach?for?the?treatment?of?vertebral?compression?fractures?caused?by?osteoporosis.