Meta-analysis Of The Efficacy Of PCVP And Unilateral Pedicle Approach PVP In The Treatment Of OVCF

Objective: To discuss the evaluation methods of bone cement distribution after vertebral augmentation in different application situations,and to systematically evaluate the effectiveness and safety of unilateral transpira curve approach and straight approach vertebroplasty in the treatment of osteoporotic vertebral compression fractures,in order to provide corresponding reference for clinical application.Methods: By combining subject words with free words,we searched the domestic and foreign databases,including China National Knowledge Infrastructure(CNKI),Chinese Medical Association,VIP,Wan Fang,China Biology Medicine Disc,Pub Med,Embase database,and Cochrane Library.A systematic review of randomized controlled trials(RCTS)on unilateral transpdicular curved approach(experimental group)and straight approach(control group)vertebroplasty for osteoporotic vertebral compression fractures from the establishment of the database to June 2022 was performed.endnote and CNKI were used for literature management,and the collected literature was screened according to the corresponding inclusion and exclusion criteria.The quality of the included literature was evaluated according to the Cochrane Handbook.After literature screening,the final included literature was determined and the data of the included literature were analyzed by Rev Man 5.0 and Stata 12.0 software.Subgroup analysis,sensitivity analysis or Meta regression analysis were performed on the analysis results with high heterogeneity.The sources of heterogeneity and possible factors leading to heterogeneity were inferred to determine whether the results were robust and credible.Results: A total of 23 randomized controlled trials were included,including 21 Chinese articles and 2 English articles.The results of Meta-analysis showed that the visual analogue scale of the experimental group was significantly lower than that of the control group [WMD =-0.26,95%CI(-0.36,-0.15),P < 0.01],which showed that the analgesic effect of the experimental group was more obvious.The excellent and good rate of bone cement distribution in the experimental group was significantly better than that in the control group [RR =1.72,95%CI(1.28,2.32),P < 0.01],which showed that the patients in the experimental group had better bone cement distribution after operation.The bone cement leakage rate of the experimental group was significantly lower than that of the control group [RR=0.36,95%CI(0.26,0.49),P < 0.05],indicating that the experimental group had a lower bone cement leakage rate.Compared with the control group,the experimental group had significant differences in operation time [WMD =-0.93,95%CI(-2.12,0.25),P < 0.05].P=0.12],vertebral re-fracture rate[RR=0.70,95%CI(0.32,1.56),P=0.389],nerve tissue injury rate [RR=0.33,95%CI(0.07,1.60),P > 0.05].However,Oswestry disability index [WMD =-4.38,95%CI(-8.27,-0.49),P<0.05] and bone cement injection volume [WMD =0.21,95%CI(-0.11,0.52),P=0.20]were due to the high heterogeneity of the included literature.Sensitivity analyses showed that the results were not robust,and conclusions should be drawn with caution.Conclusion: Compared with the straight approach,the unilateral transpedicular approach has the advantages of better pain relief,lower bone cement leakage rate,and higher excellent and good rate of bone cement distribution.There was no significant difference in operation time,vertebral re-fracture rate and nerve tissue injury rate between the two groups.However,some outcome indicators need to be further proved by more rigorous clinical controlled trials.