摘要
目的系统评价中国人骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)经皮椎体成形术(percutaneous vertebroplasty,PVP)及经皮椎体后凸成形术(percutanous kyphoplasty,PKP)术后相邻椎体再骨折的危险因素。方法通过计算机检索中国知网、万方数据库、维普、PubMed、Medline、Embase、Cochrane Library数据库,检索时间自建库至2020年11月关于PVP或PKP术后相邻椎体再骨折危险因素的文献。由2位评审员进行筛选及数据提取等工作,使用NOS量表(Newcastle-Ottawa Scale,NOS)对纳入的文献进行质量评价,并应用Revman 5.3软件进行Meta分析。结果最终纳入20篇病例对照研究,其中3篇为中质量研究,17篇为高质量研究。共包括相邻椎体骨折949例,术后未发生相邻椎体骨折5596例。抗骨质疏松治疗可降低OVCF术后邻近椎体压缩性骨折(adjacent vertebral compression fracture,AVCF)的发生OR=0.23,95%CI(0.06,0.93),P=0.04]。既往骨折病史OR=3.23,95%CI(2.05,5.09),P<0.01]、伤椎个数OR=2.08,95%CI(1.29,3.35),P<0.01]、术中骨水泥渗漏OR=3.49,95%CI(2.84,4.30),P<0.01]、注入骨水泥剂量多OR=2.41,95%CI(1.58,3.67),P<0.01]、低骨密度OR=3.26,95%CI(1.89,5.64),P<0.01]、术后椎体高度过度OR=1.37,95%CI(1.11,1.69),P<0.01]是椎体成形术后OVCF发生的危险因素,更可能导致OVCF术后AVCF的发生。结论OVCF患者术后规范的抗骨质疏松治疗,可有效降低AVCF的发生。既往骨折病史、术前伤椎个数多、术中骨水泥渗漏、注入骨水泥剂量多、低骨密度和椎体高度过度恢复是OVCF患者术后发生AVCF的危险因素。
Objective To evaluate the risk factors of adjacent vertebral re-fracture after percutaneous vertebroplasty and percutaneous kyphoplasty in Chinese patients with osteoporotic vertebral compression fracture(OVCF).Methods We searched several databases,including CNKI,Wanfang database,CQVIP database,PubMed,Cochrane Library and Embase,to identify articles that might meet the criteria.The search date ends in November 2020.Meta-analysis was performed using Revman 5.3 software.Results A total of 20 case-control studies were included,of which 3 were medium-quality studies and 17 were high-quality studies.A total of 949 cases of adjacent vertebral fractures were included,and 5596 cases without adjacent vertebral fractures were included as controls.Anti-osteoporosis therapy reduced the incidence of adjacent vertebral compression fracture(AVCF)after OVCF[OR=0.23,95%CI(0.06,0.93),P=0.04].Previous fracture history[OR=3.23,95%CI(2.05,5.09),P<0.01],the number of injured vertebrae[OR=2.08,95%CI(1.29,3.35),P<0.01],intraoperative bone cement leakage[OR=3.49,95%CI(2.84,4.30),P<0.01],the higher injection dose of bone cement[OR=2.41,95%CI(1.58,3.67),P<0.01],low bone mineral density[OR=3.26,95%CI(1.89,5.64),P<0.01)],and excessive recovery of vertebral height after operation[OR=1.37,95%CI(1.11,1.69),P<0.01]were more likely to lead to the occurrence of AVCF after OVCF.Conclusions Standardized anti-osteoporosis treatment in patients with OVCF can effectively reduce the incidence of AVCF.Previous fracture history,large number of injured vertebrae before operation,leakage of bone cement during operation,high dose of bone cement injection,low bone mineral density,large local Cobb after operation and excessive recovery of vertebral height are the risk factors of AVCF in patients with OVCF.
作者
李春涛
李文毅
高尚聚
曹参
李昌任
何靓
李萌
马旭
LI Chun-tao;LI Wen-yi;GAO Shang-ju;CAO Can;LI Chang-ren;HE Liang;LI Meng;MA Xu(Graduate School, Hebei North University, Zhangjiakou 075000, Hebei, China;Department of Orthopedics,Hebei General Hospital, 050000 Shijiazhuang, China;Graduate School, Hebei Medical University,Shijiazhuang 050000, China)
出处
《中华骨质疏松和骨矿盐疾病杂志》
CSCD
北大核心
2021年第6期638-646,共9页
Chinese Journal Of Osteoporosis And Bone Mineral Research
