ABSTRACT
BACKGROUND: Minimally invasive surgery is the main method for senile osteoporotic vertebral fractures, and percutaneous kyphoplasty (PKP) has been rapidly popularized. As the conventional bilateral transpedicular puncture needs a longer operation time and higher costs, unilateral transpedicular puncture is gradually applied in clinic. However, the long-term clinical efficacy of unilateral and bilateral PKP remains controversial. OBJECTIVE: To evaluate the effectiveness and safety of unilateral and bilateral PKP for osteoporotic vertebral fractures through a meta-analysis. METHODS: A computer-based retrieval of PubMed, Cochrane Library, Embase, Engineering Village, Web of Science, Wiley, OVID, Google Scholar, WanFang, CNKI and VIP databases was performed for the randomized controlled trials of unilateral and bilateral PKP for osteoporotic vertebral fractures through meta-analysis. Date and language of studies were not limited. Two reviewers screened the retrieved studies in accordance with the inclusion and exclusion criteria. The quality of the studies was evaluated by a modified Jadad scale prior to the meta-analysis on Review Manager 5.2 software.RESULTS AND CONCLUSION: (1) Finally, 956 patients from 11 randomized controlled trials were included and divided into two groups,unilateral group (n=483) and bilateral group (n=473) (1:1). (2) The meta-analysis results showed that the operation time in the unilateral group was significantly better than that in the bilateral group (MD=-20.38, 95%CI(-24.10, -16.65), P < 0.000 01); the dose and duration of intraoperative radiation exposure to the patients in the unilateral group were less than those in the bilateral group; the bone cement used in the unilateral group was significantly less than that in the bilateral group (P < 0.000 01); the incidence of bone cement leakage in the unilateral group was less than that in the bilateral group (P=0.005); there were no significant differences in the Visual Analogue Scale scores, vertebral height restoration, Cobb angle of the fractured vertebra and re-fracture rate of the adjacent vertebrae between two groups during long-term follow-up. (3) Compared with bilateral PKP, unilateral PKP exhibits a shorter operation time, less intraoperative radiation exposure and a lower incidence of bone cement leakage in the treatment of osteoporotic vertebral fractures, so it is a safer surgical method.