摘要
目的:椎体成形术广泛应用于骨质疏松性椎体骨折的治疗,目前聚甲基丙烯酸甲酯仍是强化椎体最常用的填充材料,但其并非是最理想的填充材料。自固化磷酸钙骨水泥是近年来研制成功的一种能够与骨组织自然愈合且被人体吸收和替代的新型填充材料。文章系统评价两种填充材料应用于椎体成形术中的临床疗效和安全性。方法:检索中国知网、万方、维普、中国生物医学文献、PubMed、EMbase、Cochrane Library数据库中有关聚甲基丙烯酸甲酯与自固化磷酸钙骨水泥治疗骨质疏松性椎体压缩骨折的临床对照研究,检索时间均从建库至2020年7月。以目测类比评分、椎体后凸Cobb角、椎体高度、骨水泥渗漏率、邻近椎体骨折率、Oswestry功能障碍指数和临床疗效作为结局指标。由2名研究员独立进行文献筛选、数据提取及研究质量评估,其中随机对照试验采用"Cochrane偏倚风险评估工具"评估质量,队列研究采用Newcastle-Ottawa量表评估质量,并使用RevMan 5.4软件进行Meta分析。结果:(1)最终纳入9项研究,其中有5项随机对照试验和4项回顾性队列研究,文献总体质量较高,共593例患者;(2)Meta分析结果显示:两种填充材料在术后疼痛目测类比评分(SMD=-0.45,95%CI:-1.10-0.21,P=0.18)、椎体后凸Cobb角(MD=-0.16,95%CI:-0.43-0.11,P=0.24)、椎体高度(SMD=0.13,95%CI:-0.12-0.37,P=0.32)、骨水泥渗漏率(OR=1.30,95%CI:0.67-2.54,P=0.44)、Oswestry功能障碍指数(MD=3.31,95%CI:-1.34-7.97,P=0.16)、临床疗效有效率(OR=1.00,95%CI:0.14-7.27,P=1.00)等方面差异均无显著性意义;但在邻近椎体新发骨折方面,自固化磷酸钙骨水泥组明显优于聚甲基丙烯酸甲酯组(OR=2.17,95%CI:1.04-4.51,P=0.04)。结论:与聚甲基丙烯酸甲酯相比,在椎体成形术中应用自固化磷酸钙骨水泥对于减少邻近椎体骨折具有显著优势,在疼痛目测类比评分、椎体后凸Cobb角、椎体高度、骨水泥渗�
OBJECTIVE: Vertebroplasty is widely used in the treatment of osteoporotic vertebral fractures. At present, polymethyl methacrylate is still the most commonly used filling material for strengthening vertebral body, but it is not the most ideal filling material. Self-curing calcium phosphate cement is a new filling material developed in recent years, which can naturally heal with bone tissue and be absorbed and replaced by the human body. This meta-analysis systematically analyzed the clinical efficacy and safety of polymethyl methacrylate and self-solidifying calcium phosphate cement in vertebroplasty. METHODS: China National Knowledge Infrastructure, Wanfang database, Chinese Biomedical Medicine database, PubMed, EMbase, and Cochrane Library database were retrieved for clinical control studies regarding with polymethyl methacrylate and self-solidifying calcium phosphate cement treatment of osteoporotic vertebral compression fracture. The retrieval period was from the database inception to July 2020. The visual analogue scale score, vertebral kyphosis Cobb angle, vertebral body height, bone cement leakage rate, adjacent vertebral fracture rate, Oswestry dysfunction index, and clinical curative effect were used as the outcome indexes. All the literature screening, data extraction and research quality evaluation were carried out independently by two reviewers. In addition, the Cochrane Collaboration tool and the Newcastle-Ottawa scale were used to evaluate the quality of randomized controlled trials and cohort studies, respectively. RevMan 5.4 software was used for meta-analysis.RESULTS:(1) A total of nine studies involving 593 patients were included in the meta-analysis;five of which were randomized controlled trials, and four were retrospective cohort studies. All of the selected studies were of high quality.(2) Meta-analysis results showed that there was no significant difference between the two filling materials in the following aspects, including visual analogue scale score(SMD=-0.45, 95%Ci:-1.10-0.21, P=0.18),
作者
欧梁
孔德忠
徐道情
倪景
付兴前
黄维琛
Ou Liang;Kong Dezhong;Xu Daoqing;Ni Jing;Fu Xingqian;Huang Weichen(Department of Orthopedics,The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550003,Guizhou Province,China;Guizhou University of Traditional Chinese Medicine,Guiyang 550312,Guizhou Province,China)
出处
《中国组织工程研究》
CAS
北大核心
2022年第4期649-656,共8页
Chinese Journal of Tissue Engineering Research
基金
贵州省中医药管理局课题(QZYY-2019-031),项目负责人:欧梁
国家级大学生创新创业训练计划项目(201910662012),项目负责人:倪景。