Mrežna meta-analiza perkutane vertebroplastike, perkutane kifoplastike, nervnog bloka i konzervativnog tretmana za nehirurške opcije akutnih/subakutnih i kroničnih osteoporotskih kompresijskih fraktura kralježaka (OVCF) u kratkoročnim i dugoročnim efektima.
Medicine
Sažetak istraživanja
Pozadina Osteoporotski kompresijski prijelomi kralježaka (OVCF) obično pogađaju većinu starijih ljudi koji rezultiraju bolom u leđima, značajnim deformitetom kralježaka, funkcionalnim invaliditetom, smanjenom kvalitetom života i povećanim susjednim prijelomima kralježnice i mortalitetom. Perkutana vertebralna augmentacija (PVA) uključuje perkutanu vertebroplastiku (PVP) i perkutanu kifoplastiku (PKP), nervni blok (NB) i konzervativno liječenje (CT) koriste se za strategiju nehirurškog liječenja OVCF, međutim, trenutna procjena njihove efikasnosti ostaje kontroverzna.
Metode i analiza Sprovedena je sistematska pretraga literature u PubMed-u, EMBASE-u, Web of Knowledge i Cochrane Centralnom registru kontrolisanih ispitivanja do 31. oktobra 2017. Nasumične kontrolisane studije (RCT) su upoređivane PVP, PKP, NB ili CT za lečenje OVCF. Rizik od pristranosti za svako ispitivanje je ocijenjen prema Cochrane priručniku. Srednje razlike (MD) sa 95% intervalima pouzdanosti (CI) korištene su za izražavanje VAS (vizuelno analogne skale) ishoda. Mrežna meta-analiza (NMA) komparativne efikasnosti mjerene promjenom VAS-a na akutne/subakutne i kronične OVCF je provedena kratkoročno (Rezultati Ukupno 18 ispitivanja među 1994 pacijenata uključeno je u NMA. PVA (PVP i PKP) je imao bolju opciju. U svim slučajevima efikasnosti PKPCT-a je bila bolja opcija. akutni/subakutni OVCF za dugotrajne i hronične OVCF za kratkoročne i dugoročne, dok je PVP imao najveću superiornost u slučaju akutnog/subakutnog OVCF za kratkoročni NB ima veću vjerovatnoću od PKP i PVP na akutni/subakutni OVCF bolji učinak od CT-a u ublažavanju akutne/subakutne i kronične OVCF-ove boli kratkoročno i dugotrajno.
Prikaži originalni naslov i sažetak na engleskom
Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects.
Background Osteoporotic vertebral compression fractures (OVCFs) commonly afflicts most aged people resulting back pain, substantial vertebral deformity, functional disability, decreased quality of life, and increased adjacent spinal fractures and mortality. Percutaneous vertebral augmentation (PVA) included percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), nerve block (NB), and conservative treatment (CT) are used for the nonsurgery treatment strategy of OVCFs, however, current evaluation of their efficacy remains controversial.
Methods and analysis A systematic literature search was carried out in PubMed, EMBASE, Web of Knowledge, and the Cochrane Central Register of Controlled Trials up to October 31, 2017. Randomized controlled trials (RCTs) were compared PVP, PKP, NB, or CT for treating OVCFs. The risk of bias for each trial was rated according to the Cochrane Handbook. Mean differences (MDs) with 95% confidence intervals (CIs) were utilized to express VAS (visual analog scale) outcomes. The network meta-analysis (NMA) of the comparative efficacy measured by change of VAS on acute/subacute and chronic OVCFs was conducted for a short-term (
Results A total of 18 trials among 1994 patients were included in the NMA. The PVA (PVP and PKP) had better efficacy than CT. PKP was first option in alleviating pain in the case of the acute/subacute OVCFs for long term, and chronic OVCFs for short term and long term, while PVP had the most superiority in the case of the acute/subacute OVCFs for short term. NB ranks higher probability than PKP and PVP on acute/subacute OVCFs in short and long-term, respectively.
Conclusions The present results suggest that PVA (PVP/PKP) had better performance than CT in alleviating acute/subacute and chronic OVCFs pain for short and long-term. NB may be used as an alternative or before PVA, as far as pain relief is concerned. Various nonsurgery treatments including CT, PVA (PVP/PKP), NB, or a combination of these treatments are performed with the goal of reducing pain, stabilizing the vertebrae, and restoring mobility.
Izvorni podaci
- DOI
- 10.1097/md.0000000000011544
- PMID
- 30024546
- PMCID
- PMC6086478
- Provjereno
- 2026-07-26
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