Clinical Efficacy And Complications Of Unilateral Versus Bilateral Percutaneous Kyphoplasty For Curing Compression Fracture Of The Vertebral Body Caused By Osteoporosis:A Meta-analysis

BACKGROUNDNowadays,one of the most commonly used mini-traumatic surgery methods for the treatment of osteoporotic vertebral compression fractures is percutaneous kyphoplasty,which has obvious therapeutic effects,especially in relieving patients’ back pain and correcting kyphotic deformities.In all aspects,it can greatly improve the quality of life of patients.Among them,unilateral approach and bilateral approach are the two more important surgical methods for kyphoplasty.Although there have been many research literatures comparing these two surgical approaches,there is still debate about which surgical approach is better,safer,and has fewer complications for the treatment of osteoporotic vertebral compression fractures.There is a lack of uniform guidance standards.Therefore,we need to provide more and more reliable clinical medical research evidence for reference.OBJECTIVEIn order to guide the choice of clinical surgery,the safety and efficacy of the two approaches of percutaneous kyphoplasty in curing compression fracture of the vertebral body caused by osteoporosis were analyzed and evaluated by Meta analysis.METHODSWe use computers to search a large number of databases before January 2021,such as related Chinese databases such as China Weipu,Wanfang,and CNKI,and English databases such as CBM,Embase,Web of Science,Cochrane,and Pub Med.We reviewed the published literature on the two operative randomized controlled trials of percutaneous kyphoplasty in the treatment of osteoporotic vertebral compression fractures in domestic and foreign libraries,and we will non-randomized Controlled trials,review literature,retrospective studies,etc.are excluded,and relevant conference papers and authoritative journals in the field are manually searched.Finally,relevant high-quality documents that meet the requirements are included,and relevant data are extracted from them for comparison.The extracted content includes the operation time,the number of surgical radiations,the surgical radiation time,the amount of bone cement,the early and mid-late postoperative VAS scores,the comparison of postoperative anterior column,middle column height and cobb angle,and a series of post-operative complications: Such as bone cement leakage and adjacent vertebral fractures.We refer to the Cochrane Handbook,the quality of the included literature was independently evaluated by 2 reviewers according to the manual content standards,and Rev Man 5.3 computer software was used for statistical analysis,and finally the data objects of the symbol standard were obtained.RESULTS AND CONCLUSION1.In the end,11 articles of randomized controlled trials that met the standards were included.A total of 1209 patients underwent kyphoplasty,including 604 patients with unilateral approach and 605 patients with bilateral approach;2.According to the results of the Meta analysis,the operation time of the unilateral approach is shorter than that of the bilateral approach [MD=-18.25,95%CI(-25.50,-11.01),P <0.000 01].The unilateral approach takes less time and frequency for patients to receive X-rays than the bilateral approach during surgery.The volume of bone cement used during unilateral approach is less than that of bilateral approach(P <0.000 01).The incidence of bone cement leakage after unilateral approach is lower than that of bilateral approach(P=0.007);The leakage rate of bone cement after unilateral approach is lower than that of bilateral approach(P=0.007).However,in the postoperative follow-up patients,the VAS score,the height of the vertebral body,the cobb angle,the re-fracture rate of the adjacent vertebral body,and the ODI score,the effects of the two surgical methods are statistically insignificant;3.The results show that comparing the efficacy of unilateral approach and bilateral approach,both can significantly relieve the patient’s back pain and restore the height and function of the vertebral body.Therefore,the therapeutic effects of the two surgical methods are generally the same;but from the perspective of safety,the unilateral puncture operation time is short,the patient’s radiation dose is small,and the bone cement leakage rate is low,which reduces the intraoperative risk and postoperative complications.Therefore,for patients suffering from osteoporotic vertebral compression fractures,the choice of unilateral approach can be the first choice for kyphoplasty.