椎體后凸成形術治療骨質疏松導致的椎體骨折兩種手術入路的療效和并發癥分析

高飛 魏來福 章益群 涂必治 錢軍

摘?要：目的：通過Meta分析對治療骨質疏松性椎體骨折中穿刺椎體后凸成形術的兩種術式的安全性和療效進行分析評價，以便指導臨床手術方式選擇。方法：通過計算機檢索2021年1月之前大量數據庫。最終納入相關符合要求的文獻進行研究。根據Cochrane手冊，所納入文獻質量由2位評價員根據手冊內容標準獨立進行評價，統計分析上用RevMan?5.3軟件，以獲得分析結果。結果與結論：（1）最終11篇符合要求文獻被納入研究，患者一共有1209例，包括604例單側穿刺患者和605例的雙側穿刺患者;（2）Meta分析得出的結果顯示：醫生在操作時間、患者在術中接受X射線的時間、術中患者透視次數、術中骨水泥使用體積、術后骨水泥泄露發生人數上有明顯差異（P<0.01）;但術后隨訪的患者中，兩種入路在手術后VAS評分、恢復的椎體高度、后凸角、再次發生相鄰椎體骨折、ODI評分等方面從統計學上看無意義（P>0.05）。（3）結果表明：兩種手術入路術后效果大體一致，但與雙側穿刺相比，單側穿刺治療具有操作時間短，術中接受輻射少，術后并發癥少等優點，因此單側入路應作為治療骨質疏松導致椎體壓縮骨折的標準入路。

關鍵詞：骨質疏松性椎體壓縮性骨折;經皮穿刺椎體后凸成形術;椎體后凸成形術;單側穿刺;單側入路;雙側穿刺;雙側入路;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.