特立帕肽保守治疗骨质疏松性脊柱骨折:12例报告  

Teriparatide for conservative treatment of osteoporotic vertebral fracture: analysis of 12 cases

作　　者：杨德鸿[1] 胡少宇 孟越[1] 童国军[1] 陈建庭[1] 

机构地区：[1]南方医科大学南方医院脊柱骨科,广东广州510515

出　　处：《南方医科大学学报》2016年第3期414-418,共5页Journal of Southern Medical University

基　　金：国家自然科学基金(81272043)~~

摘　　要：目的根据随访病例分析在保守治疗骨质疏松性脊柱骨折中特立帕肽的促骨折愈合作用。方法 12例绝经后女性患者,年龄73±4.8岁。所有患者接受6个月特立帕肽皮下注射,并接受钙剂补充和对症止痛治疗。在治疗开始后0和6个月,双能X线骨密度仪测量骨密度,胸腰椎正侧位X片测量胸腰椎形态,P1NP/beta-CTX化验患者骨代谢情况,6例患者在治疗结束时复查MRI了解骨折愈合情况。0和6个月时,VAS疼痛和患者生存质量(ODI)评分在门诊完成,1个月时电话完成。结果所有的12例患者完成随访,在治疗中无新发骨折,无不良事件出现。治疗的第1个月末所有患者不再需要止痛剂辅助治疗。VAS评分从8±2降低至1±2。ODI评分从(76±12)%(注射前)降低至(20±5)%(注射后1月),然后至(5±4)%(6月)。伤椎前后柱高度百分比值从(75±20)%下降至(61±20)%。P1NP从20.9±11.4 ng/m L上升至80.0±41.2 ng/m L。CTX从0.30±0.17 ng/m L上升至0.51±0.3 ng/m L。骨密度增加(20±5)%。6例患者获得MRI复查,见骨折愈合。结论特立帕肽保守可以有效治疗骨质疏松性脊柱骨折。此方法可以促进骨折愈合,提高患者生存质量,防止骨折椎体塌陷。可以作为PVP或BV手术的替代方法。Objective To evaluate the efficacy of conservative treatment with teriparatide for promoting bone fracture healing in patients with osteoporotic vertebral fracture. Methods Twelve postmenopausal patients（aged 73±4.8 years） with osteoporotic spinal fracture confirmed by MRI or CT scanning received conservative treatment with teriparatidesc injection supplemented with calcium and analgesics for 6 months. At the beginning and at the end of the therapy, VAS score, Oswestry Disability Index（ODI）, bone mass densitometry, and X- ray of the thoracic and lumbar spine, and serum P1 NP and beta- CTX levels were measured. Six of the patients received a second MRI scan after the therapy to evaluate the bone healing. Results All the 12 patients completed the treatment, during which no new fractures or adverse events occurred. At the end of the first month of treatment, analgesic was withdrawn for all the patients. The average VAS score decreased from 8±2 to 1±2 at 1 month during the therapy, and ODI was reduced from（76±12）% to（20±5）% at 1 month and further to（5±4）% at 6 month. After the 6-month therapy, the height of the fractured vertebrae（presented as the anterior to posterior wall height ratio） was insignificantly decreased from（75±20）% to（61±20）%, the BMD was increased by（20±5）%, P1 NP increased significantly from 20.9±11.4 ng/m L to 80.0 ± 41.2 ng/m L, and beta- CTX increased from 0.30 ± 0.17 ng/m L to 0.51 ± 0.3 ng/m L. The 6 patients re- examined with MRI demonstrated complete bone healing after the therapy. Conclusion Teriparatide is effective for conservative treatment of osteoporotic spinal fracture and can promote bone fracture healing, improve the quality of life, and prevents vertebral collapse,and can be therefore an alternative treatment to PVP or BV.

关 键 词：骨质疏松性脊柱骨折 椎体成形术 球囊成形术 特立帕肽 

分 类 号：R683[医药卫生—骨科学]