| 标题： | 骨质疏松性胸腰椎压缩骨折椎体强化术后椎体再骨折防治指南（2024版） |
| title： | Guidelines for the Prevention and Treatment of Vertebral Refracture after Vertebral Augmentation for Osteoporotic Thoracolumbar Compression Fracture (2024 Edition) |
| 版本： | 原创版 |
| version： | Original |
| 分类： | 标准指南 |
| classification： | Standard guideline |
| 领域： | 诊疗 |
| field： | Diagnosis and Treatment |
| 国家和地区： | 中国 |
| Country and region： | China |
| 指南使用者： | 脊柱外科医师 |
| Guide users： | Spine surgeon |
| 证据分级方法： | 采用建议分级的评估、制订及评价（GRADE）分级体系对证据的质量进行分级。Ⅰ级为前瞻性随机对照研究，Ⅱ级为前瞻性非随机对照研究，Ⅲ级为回顾性病例对照研究，Ⅳ级为病例系列报告。 推荐等级与文献等级评定标准对应，推荐强度分为3级，从1~3级依次递减。1级推荐：（1）差异有统计学意义的高质量Ⅰ级证据研究，或虽然差异无统计学意义，但可信区间很窄的高质量Ⅰ级证据研究；（2）Ⅰ级证据研究的系统综述（前提是这些纳入的研究结果具有同质性）。2 级推荐：（1）质量稍次的Ⅰ级证据研究（如随访率<80%、非盲法对照、随机化分组不合适）；（2）Ⅱ级证据研究；（3）研究结果不同质的Ⅰ级证据研究的系统性综述；（4）Ⅱ级证据研究的系统综述。3级推荐：Ⅲ级或Ⅳ级证据研究。 |
| Evidence grading method： | Use GRADE(Grading of Recommendations Assessment，Development，and Evaluation) assess the hierarchy of evidence.Level I is a prospective randomized controlled study, level II is a prospective non-randomized controlled study, level III is a retrospective case-control study, and level IV is a case series report. The recommendation level corresponds to the literature rating standard, and the recommendation intensity is divided into 3 levels, decreasing from 1 to 3. Level 1 recommendation: (1) High quality Level I evidence studies with statistically significant differences, or high quality Level I evidence studies with narrow confidence intervals although the differences are not statistically significant; (2) A systematic review of Level I evidence studies (provided that these included studies are homogeneous). Level 2 recommendation: (1) Level I evidence studies of lower quality (e.g., follow-up rate <80%, non-blind control, randomization is not appropriate); (2) Level II evidence research; (3) A systematic review of the results of different quality Level I evidence studies; (4) Systematic review of Level II evidence studies. Level 3 recommendation: Level III or Level IV evidence study. |
| 制定单位： | 中国医师协会骨科分会脊柱创伤专业学组 |
| Formulating unit： | Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association |
| 注册时间： | 2024-11-04 |
| Registration time： | |
| 注册编号： | PREPARE-2024CN030 |
| Registration number： | |
| 指南制订的目的： | 随着人口老龄化的进展,由于骨质疏松导致的脊柱压缩性骨折越来越多。脊柱最容易发生骨质疏松骨折的节段是胸腰段。对于骨质疏松性胸腰椎压缩骨折，临床上最常用的治疗方式是椎体强化术（如经皮椎体成形术以及经皮椎体后凸成形术），这类术式具有良好的止痛效果以及快速恢复患者活动能力等优势，符合ERAS康复理念。但是术后部分患者出现椎体再骨折的情况，严重影响了患者生活质量，也给临床医师带来很多困扰。如何预防及处理椎体再骨折，一直是脊柱外科医师讨论的焦点问题，且目前缺乏这方面的专家共识和临床指南。基于上述现状，由中国医师协会骨科分会脊柱创伤专业学组牵头，通过系统文献回顾，经国内脊柱专家代表讨论，基于循证医学基础，拟共同制定本指南，以期为骨质疏松性胸腰椎压缩骨折椎体强化术后椎体再骨折的规范化防治提供参考。 |
| Purpose of the guideline： | As the aging population progresses, spinal compression fractures due to osteoporosis are becoming more common. The segment of the spine most prone to osteoporotic fractures is the thoracolumbar segment. For osteoporotic thoracolumbar compression fractures, the most commonly used clinical treatment is vertebral body strengthening (such as percutaneous vertebroplasty and percutaneous kyphoplasty), which has the advantages of good pain relief and rapid restoration of the patient's mobility, which is in line with the rehabilitation concept of ERAS. However, some patients have vertebral re-fracture after surgery, which seriously affects the patients' quality of life and brings a lot of trouble to spine surgeons. How to prevent and manage vertebral body re-fracture has been the focus of discussion among spine surgeons, and there is a lack of expert consensus and clinical guidelines in this area. Based on the above, led by the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association, through a systematic literature review, discussed by the representatives of domestic spine experts, and based on evidence-based medicine, we intend to work together to formulate this guideline. with a view to providing reference for the standardization of vertebral re-fracture prevention and treatment after vertebral body strengthening for osteoporotic thoracolumbar compression fractures, to improve the clinical prognosis of patients, and to save medical costs. |
