Vertebral augmentation effective in osteoporotic vertebral compression fracture at 1 year .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(24):31 PLoS One. 2015 Sep 17;10(9):e01381268 randomized controlled trials were included in this meta-analysis for the purpose of comparing pain relief, spinal function, and quality of life in percutaneous vertebral augmentation (PVA) in comparison to conventional treatment for painful osteoporotic vertebral compression fractures. Pain scores, spinal functional outcomes, and quality of life were all significantly in favor of the percutaneous vertebral augmentation groups up to 1 year post-operatively in comparison to conventional treatment. Subgroup analysis indicated that percutaneous vertebral augmentation in fractures less than 3 months old would cause greater pain relief.
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نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
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Introduction
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Accessing Data
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Analysing Data
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Results
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
The use and efficacy of percutaneous vertebral augmentation (PVA), such as vertebroplasty and balloon kyphoplasty, has been a topic of debate in the treatment of painful osteoporotic vertebral compression fractures. A number of reports have shown conflicting results ultimately altering the treatment recommendations for these fractures. Recent randomized controlled trials (RCTs) had been published comparing vertebroplasty and balloon kyphoplasty to conventional treatment in painful osteoporotic VCFs and thus the present study was prudent to provide an updated assessment of available high-quality literature.
ما هو سؤال البحث الرئيسي؟
How do the clinical differences in pain relief, spinal functional outcomes, and overall quality of life compare between percutaneous vertebral augmentation and conventional treatment for the management of painful osteoporotic vertebral compression fractures?
- VAS pain in the early-term follow-up (1 week to 1 month), middle-term follow-up (2-3 months) and the late-term follow-up (1 year) all significantly favored the experimental group (Early: 7 studies; SMD 0.30 [95% CI 0.09, 0.51]; p=0.005; I2=77.9% | Middle: 7 studies; SMD 0.28 [95% CI 0.14, 0.42]; p=0.000; I2=51.3% | Late: 5 studies; SMD 0.26 [95% CI 0.12, 0.41]; p=0.000; I2=41.5%). Sensitivity analysis did not alter these results.
- Subgroup analysis of VAS scores indicated that the efficacy of vertebroplasty and balloon kyphoplasty on pain relief was greater than conventional treatment at all timepoints and that the difference was significant with the exception of vertebroplasty in the early follow-up (p=0.06)
- No difference in pain was noted between vertebroplasty and sham treatment in the early and middle term follow-up
- Subgroup analysis of VAS score suggested that patients with PVA performed with a fracture age of less than 3 months would get earlier pain relief than control group, and that MRI is beneficial as inclusion criteria at all time points (p<0.05)
- Spinal functional outcomes in the early-term, middle-term, and late-term follow up all significantly favored the experimental group (Early: 6 studies; SMD 0.32 [95% CI 0.10, 0.54]; p=0.004; I2=75.7% | Middle: 5 studies; SMD 0.24 [95% CI 0.05, 0.42]; p=0.011; I2=65.2% | Late: 3 studies; SMD 0.26 [0.14, 0.38]; p=0.000; I2=0%). Sensitivity analysis did not change the significance of these results (p<0.001).
- Quality of life outcomes in the early-term, middle-term, and late-term follow up all significantly favored the experimental group (Early: 6 studies; SMD 0.23 [95% CI 0.14, 0.33]; p=0.000; I2=0% | Middle: 4 studies; SMD 0.23 [95% CI 0.05, 0.41]; p=0.012; I2=60.3% | Late: 3 studies; SMD 0.23 [95% CI 0.11, 0.34]; p=0.000; I2=0.6%), sensitivity analysis did not alter these results.
- There was no significant difference in the risk of new VCFs (7 studies) or adjacent VCFs (5 studies) between 2 weeks and 2 years between the experimental and control groups (RR 1.09 [95% CI 0.61, 1.97]; p=0.77 and 1.80 [95% CI 0.61, 5.30]; p=0.28, respectively)
ما الذي يجب أن أتذكره أكثر؟
Pain scores, spinal functional outcomes, and quality of life were significantly in favor of the percutaneous vertebral augmentation groups in the early, middle, and late term follow-up (up to 1 year) in comparison to control treatments. Subgroup analysis indicated that patients receiving percutaneous vertebral augmentation with a fracture age less than 3 months would get earlier pain relief than the control group.
كيف سيؤثر ذلك على رعاية مرضاي؟
The results of this study indicate that percutaneous vertebral augmentation for the treatment of osteoporotic vertebral compression fractures may provide improvements in pain, spinal function, and quality of life in comparison to control treatments up to 1 year post-operatively. Further high quality RCTs are needed to add to the current body of literature and examine if differences clinically meaningful.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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