| Objective The main purpose of this paper is to analysis new vertebral fractures,through respective analysis of clinical data of patients who meet the criteria,after vertebroplasty(PVP) or kyphoplasty(PKP) during the follow-up after treated by one of the two methods. And we can further explore whether both new methods increase the rate of non-treatment vertebral fractures.Methods In this study, we first observed the clinical cases and read plenty of literature, and raised doubts. And then we made a meta analysis to explore whether the PVP or PKP will increase the rate of non-treated vertebral fractures by systematic review.Part 1The clinical data of this research came from the First Center Clinical College of Tianjin Medical University from January 2010 to December 2014, all the datas were osteoporotic vertebral compression fractures after PVP or PKP. There were 225 cases contain 352 vertebraes, 78 males, 147 females, aged 53 to 92 years, with an average of 71.10 years. We counted the new non-treated vertebral fractures during the follow-up of postoperative patients. There were 215 cases who underwent a single vertebropalsty, 10 patients were randomly incorporated into the group A, the other all10 patients with non-treated vertebral fractures occurred more than one time new fracture incorporated into group B. The measurement were denoted by mean ±SD,count data were denoted by rate or percentage. Statistical analysis was performed using SPSS 19.0 software, descriptive statistics the features of cases.Part 2In addition to the Cochrane Central Register of Controlled Trials, databases such as Pub Med,ISI Web of Science, ELSEVIER Science Direct, and Embase were searched for articles on new fractures after vertebroplasty and kyphoplsty for painful OVCF. And we also filter out those articles which met the inclusion and exclusion criteria or reference. All studies were reviewed by two reviewers independently, and doing literature screening,data extractioin and quality assessment using the guidelines set by the QUOROM(Quality of Reporting of Meta-analysis) statement, and analysisusing Rev Man 5.3 software Meta analysis. We used I2 and chi-square test for heterogeneity of the studies included in the test using quantitative and qualitative assement simultaneously when P <0.05(bilateral) was considered statistically significant.Fixed model for quantitative analysis when heterogeneity is not high and less than 50%( I2),otherwise on the use of stochastic models. In addition, for those variables which may have an impact on results because of two different treatments,we used subgroup analyzes to explore.P<0.05(bilateral) was considered statistically significant.ResultsPart 1The basic information of patients of new vertebral fracture is as follows: 4male,6 female; age 71.10 ± 8.35;BMD-3.69 ± 0.35; the first volume of single vertebrae bone cement injection of PVP procedure was 5.35±0.58 ml. This 10 patients of a total 13 secondary vertebral fractures, including three adjacent vertebral fractures and other ten new vertebral fractures are non-adjacent vertebral treatment. Of this 10 patients,3 cases had experienced 3 or more times of osteoporotic vertebral compression fractures(there were three new fractures are adjacent to the previous vertebral fracture body).Part 2According to inclusion and exclusion criteria, 12 were included in our literature including 1,328 patients(768 cases of patients underwent PVP treatment,other 560 people receiving non-surgical treatment).The overall result of publication bias was measured with a funnel plot, we did not found evidence of bias. Analysis of heterogeneity of the original included studies is 41%,that is I2,=41%, say the heterogeneity is low. For the new issue of osteoporotic vertebral compression fracture,our meta analysis found no statistically significant difference in this two treatments,including the total of new vertebral fractures(P=0.55), and the adjacent vertebral fracture(P=0.5); For the pre-existing vertebral fractures, the two treatments(surgical and non-surgical treatment group) also had no significant difference(P=0.24); in addition, the bone density, including the lumbar spine(P=0.13) and femoral neck(P=0.37), and both groups had no statistically significant difference.Conclusions(1)Vertebroplasty(PVP) or kyphoplasty(PKP) can quickly relieve the patents’ pain with osteoporotic vertebral compression fractures so that patients may do early functional exercises and go back to normal daily activities.(2)There still has trend that it may occur new vertebral fractures after PVP or PKP, and this type of fracture tend to occur in adjacent vertebral body. However, as the patients we selected in both groups were all retrospective studies and they were relatively less, so the statistic results may unreliable and further randomized controlled clinical trials or high-quality meta-analysis is still needed to summarize and infer.(3)The meta analysis show that vertebroplasty(PVP) or kyphoplasty(PKP) does not increase the risk of new vertebral fractures, especially the adjacent vertebral body in the treatment of OVCF compared to traditional conservative treatment. So, in the context of the current situation, we do not need to worry about this minimally invasive procedure that it can lead to other vertebral fractures. |
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