Three Treatment Methods For Osteoporotic Vertebral Compression Fractures: A Systemic Review And Meta-Analys

PartⅠ: Percutaneous Kyphoplasty Versus Conservative Treatment in Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-AnalysisPurpose: To comprehensively compare the efficacy and safety of PKP and conservative treatment in OVCF by systematic review.Methods: The CNKI,CBM,Wan Fang Data,VIP,Pub Med,the Cochrane Library(June 2017),and EMbase database were searched up to June 2017,and identified articles were screened by two independent reviewers and assessed for inclusion.The RCT of PKP versus conservative treatment of OVCF was collected.The meta-analysis was carried out by using Rev Man 5.3software after two independently reviewers screened the literature,extracted data and evaluated the risk of bias included in the study.Results: A total of 12 literatures were included in 9 RCT studies,with a total of 1156 patients.The results showed that the VAS scores and kyphosis rate of PKP group were significantly lower in patients after short-term and mid-term follow-up,and the difference was statistically significant.However,after long-term follow-up,the results of meta-analysis showed that there was no statistical difference in VAS scores,vertebral refracture rate and complication rate between the two groups.The quality of life scores of PKP were significantly increased at each follow-up point.In the PKP group,the anterior and middle height of the vertebral body were significantly higher than that in the conservative treatment group,and the difference was statistically significant.The height loss of the vertebral body was significantly lower than that of the conservative treatment group,and the difference was statistically significant.Conclusion: PKP may have similar effects and safety compared with conservative treatment,and short-term efficacy is positive.However,due to the limitation of the quality and follow-up time of the study,more long-term follow-up samples and high-quality RCT studies were needed to further verify the conclusions of this study.Part Ⅱ: Percutaneous Kyphoplasty Versus Percutaneous Vertebroplasty for Treatment of Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-AnalysisObjective: To comprehensively compare the efficacy and safety of percutaneous kyphoplasty(PKP)and percutaneous vertebroplasty(PVP)in osteoporotic vertebral compression fracture(OVCF)by systematic review.Method: The CNKI,CBM,WanFang Data,VIP,PubMed,the Cochrane Library(June 2017),and EMbase database were searched up to June 2017,and identified articles were screened by two independent reviewers and assessed for inclusion.The randomized controlled trial of PKP versus PVP for OVCF was collected.The meta-analysis was carried out by using Rev Man 5.3software.Results: A total of 12 literatures were included in 11 RCT studies,with a total of 1138 patients.The results of meta-analysis showed that the VAS score of PVP group and PKP group showed no statistical difference at each follow-up point.There was no statistical difference between the PKP group and the PVP group in the mid-term follow-up of ODI index.In PKP group,the height loss rate of the fracture vertebral body was significantly lower than that of PVP at the time of follow-up.Patients with PKP group were significantly lower than the PVP group.Long-term follow-up showed no statistical difference in the incidence of vertebral refracture in PKP group and PVP group,and there was no statistical difference between PKP group and PVP postoperative bone cement leakage rate.Conclusion: Compared with PVP,PKP did not significantly improve the pain relief and functional activity of patients.However,after PKP operation,the vertebral height and kyphosis angle were significantly improved,and there was no difference in safety of PVP.Due to the limitations of the study follow-up time,the reliability of the above conclusions requires more long-term follow-up of high-quality RCT studies.Part Ⅲ: Percutaneous Vertebroplasty Versus Conservative Treatment in Osteoporotic Vertebral Compression Fracture: A Systematic Review and Meta-AnalysisObjective: To comprehensively compare the efficacy and safety of PVP and conservative treatment in OVCF by systematic review.Method: The CNKI,CBM,Wan Fang Data,VIP,Pub Med,the Cochrane Library(July 2017),and EMbase database were searched up to July 2017,and identified articles were screened by two independent reviewers and assessed for inclusion.The randomized controlled trial of PVP versus conservative treatment for OVCF was collected.The meta-analysis was carried out by using Rev Man 5.3 software.Results: A total of 15 literatures were included in 14 RCT studies,with a total of 1581 patients.The results showed that the VAS score of PVP group was significantly lower than the conservative treatment group at different follow-up points,and the differences were statistically significant.The score of the ODI for PVP was significantly lower than that of the conservative treatment group at different follow-up points.There was no statistical difference between the PCS and MCS in the PVP group and the conservative treatment group.The postoperative vertebral height of PVP group was significantly higher than that of conservative treatment group,and the difference was statistically significant.The incidence of vertebral refracture in PVP group and conservative treatment group was no statistically significant in the short-,med-and long-term follow-up.The complication rate of PVP group was significantly lower than that of conservative treatment group.Conclusion: The current study indicated that compared with conservative treatment,the efficacy of PVP in patients with OVCF was obvious,and there was no significant difference in safety between PVP and conservative treatment after long-term follow-up.However,with the limitation of the quality of the study,more high-quality and large-sample RCTs were needed to evaluate the efficacy and safety of PVP.