标题：椎体后凸成形术治疗骨质疏松性椎体压缩性骨折行单侧与双侧入路疗效评价的Meta分析

      作者：龙江超，张泽奎，胡林虎    阿坝藏族羌族自治州人民医院外科 ICU，四川 阿坝州 624000

      卷次： 2019年30卷9期

      【摘要】 目的 比较椎体后凸成形术单侧与双侧入路治疗骨质疏松性椎体压缩性(OVCF)的疗效优劣。方法 计算机检索Pubmed、Embase、Web of science、Cochrane Library、中国知网、万方数据库、维普数据库从建库到2018年8月的文献，检索通过单侧和双侧入路椎体后凸成形术(PKP)治疗骨质疏松性椎体压缩性骨折的中英文文献，排除重复研究、回归性分析，纳入随机对照试验，由两名评价员按照纳入和排除标准对文献质量进行评价和筛选，运用Review Manager 5.3软件进行Meta分析。结果 共纳入随机对照试验文献13篇，共1 072例患者，行手术单侧入路者534例，双侧入路者538例。Meta分析结果显示，椎体后凸成形术单侧入路与双侧入路在手术时间、骨水泥注入量、术中透视次数方面比较差异均有显著统计学意义(P<0.01)；两种手术入路方式在术后VAS评分、骨水泥渗漏率、术后 cobb角、椎体前缘高度恢复率、术后ODI评分方面比较差异均无统计学意义(P≥0.05)。结论 椎体后凸成形术单侧入路在手术时间、患者和术者术中所承受的放射量均少于双侧入路，双侧入路的骨水泥使用量也明显多于单侧，因此对于大多中老年OVCF，行单侧入路手术更有利。
      【关键词】 骨质疏松性椎体压缩性；椎体后凸成形术；单侧入路；双侧入路；Meta分析
      【中图分类号】 R683 【文献标识码】 A 【文章编号】 1003—6350（2019）09—1205—06

Meta-analysis of the efficacy of vertebral kyphoplasty in the treatment of osteoporotic vertebral compressionfractures with unilateral and bilateral approaches.
LONG Jiang-chao, ZHANG Ze-kui, HU Lin-hu. Surgical IntensiveCare Unit, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture, Aba 624000, Sichuan, CHINA
【Abstract】 Objective To compare the advantages and disadvantages of unilateral and bilateral approach in ver-tebral kyphoplasty for the treatment of osteoporotic vertebral compression fractures (OVCF). Methods The electronicdatabases of Pubmed, Embase, Web of Science, Cochrane Library, the China National Knowledge Infrastructure(CNKI), the Wanfang Database, the VIP database were searched for the Chinese and English literature in the treatment ofosteoporotic vertebral compression fractures by unilateral and bilateral vertebral percutaneous kyphoplasty (PKP) fromthe establishment of these database to August 2018. Duplicate studies and regression analyses were excluded, and ran-domized controlled trials were included. The quality of the literature was evaluated and screened by two reviewers ac-cording to inclusion and exclusion criteria. The meta-analysis was conducted using Review Manager 5.3 software.Results A total of 13 randomized controlled trials were included, with a total of 1 072 patients, including 534 patientswho underwent unilateral approach and 538 patients who underwent bilateral approach. Meta-analysis results showedthat the unilateral approach and bilateral approach in kyphoplasty had statistically significant differences in terms of oper-ative time, the volume of bone cement injection, and the number of intraoperative fluoroscopy (P<0.01). There were nosignificant differences in the postoperative VAS score, bone cement leakage rate, postoperative cobb angle, vertebralbody height recovery rate, and postoperative ODI score (P≥0.05). Conclusion The operation time, the radiation vol-ume of patients and surgeons during operation in kyphoplasty using unilateral approach are less than those using bilateralapproach. The volume of bone cement used in the bilateral approach is also significantly more than that in the unilateralapproach. Therefore, for most middle-aged and elderly OVCF, unilateral approach is more beneficial.
      【Key words】 Osteoporotic vertebral compression; Vertebral kyphoplasty; Unilateral approach; Bilateral ap-proach; Meta-analysis·荟萃分析·doi:10.3969/j.issn.1003-6350.2019.09.036