唑来膦酸联合单侧穿刺PKP术治疗老年骨质疏松性椎体压缩性骨折的疗效及不良反应的预防  

Zoledronic Acid Combined with Unipedicular PKP for the Treatment of Senile Single Segmental Osteoporotic Vertebral Compression Fractures and the Prevention of Adverse Reactions

作　　者：李鲲[1] 张坤[1] 赵胜豪[1] 黄振峰 丁凡[1] 勘武生[1] Li Kun Zhang Kun Zhao Shenghao et al(Department of Spine Surgery,PuPal Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology ,Wuhan 430030 ,Chin)

机构地区：[1]华中科技大学同济医学院附属武汉市普爱医院脊柱外科,武汉430033

出　　处：《华中科技大学学报（医学版）》2017年第5期600-603,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：卫生部卫生行业专项项目(No.W2014ZT294)

摘　　要：目的观察经皮球囊扩张椎体成形术(PKP)联合静滴唑来膦酸治疗老年骨质疏松性椎体压缩性骨折(OVCF)的疗效及超前预防性使用非甾体消炎镇痛药西乐葆对静滴唑来膦酸后急性期不良反应(APR)的预防治疗效果。方法回顾性分析武汉市普爱医院于2010年1月至2013年12月采用单侧PKP术治疗单节段老年骨质疏松性椎体压缩性骨折并获得1年以上随访的患者116例,根据患者术后是否应用唑来膦酸(密固达)分为A(试验组,67例)、B(对照组,49例)两组,其中A组PKP术后3d使用唑来膦酸,根据是否在静滴唑来膦酸前3d给予西乐葆口服,又将A组分为C(非西乐葆组,30例)、D(西乐葆组,37例)两组。分别测量A组和B组患者术前及术后1年的骨密度,对PKP术后邻近椎体骨折(AVF)的发生率进行统计,术前、术后随访时采用疼痛视觉模拟评分(VAS)评估疼痛程度,采用Oswestry评分评估活动能力,并对骨折椎体高度及Cobb角变化进行分析,评估PKP联合唑来膦酸治疗老年骨质疏松性椎体压缩性骨折的疗效。同时观察C组和D组APR的发生率,发热程度及肌肉骨骼疼痛程度的差异,评估超前预防性使用西乐葆对静滴唑来膦酸后APR的预防效果。结果治疗1年后A组患者股骨近端骨密度明显提高,治疗后1年内无新发椎体骨折的发生,B组术后1年期间有脊柱骨性疼痛加重趋势,随访期间新发椎体骨折10例,其中新发AVF 6例。两组患者术后伤椎椎体高度、Cobb角、VAS评分和Oswestry评分均较术前明显改善,差异有统计学意义(均P<0.05),但术后两组间比较无显著性差异。C组和D组APR发生率、发热及肌肉骨骼疼痛程度差异均有统计学意义(均P<0.01)。两组患者均无其它不良反应发生。结论唑来膦酸联合PKP技术治疗老年骨质疏松性骨折效果显著,可明显提高骨质疏松性患者骨密度,预防骨量持续丢失,提高患者生活质量,并有效减轻全身及脊柱骨性疼痛�Objective To observe the efficacy of zoledronic acid（Aclasta）combined with unipedicular percutaneous balloon kyphoplasty（PKP）in the treatment of senile single segmental osteoporotic vertebral compression fractures,and investigate the preventive effect of prophylactic use of non-steroidal anti-inflammatory drug celebrex on acute-stage adverse reactions（APR）after intravenous injection of zoledronic acid.Methods The clinical data of 116 patients with senile single segmental osteoporotic vertebral compression fractures,who received unipedicular PKP in our department from January 2010 to December 2013 and were followed-up,were retrospectively analyzed.According to the application of zoledronic acid after PKP or not,the patients were divided into group A（experimental group,n=67）and group B（control group,n=49）.Patients in group A received zoledronic acid for three days after PKP.According to the prophylactic application（3days in advance）of the non-steroidal anti-inflammatory drug celebrex or not,the patients in group A were divided into group C（non-celebrex group,n=30）and group D（celebrex group,n=37）.The bone mineral density（BMD）of the proximal femur,visual analogue scale（VAS）,Oswestry scores,vertebra height and Cobb angle were measured before and after treatment.The occurrence rate of the adjacent vertebral fractures（AVF）was calculated.The occurrence rate of APR was calculated,and the fever and musculoskeletal pain were observed in group C and group D.Results After 1-year treatment,the BMD of the proximal femur improved significantly in experimentalgroup compared with control group.The spine pain was continuously alleviated,and no new vertebral fractures were observed in experimental group.The spine pain became more severe in control group and 10 patients had new osteoporotic vertebral fractures,including 6cases of AVF.The vertebral height,Cobb angle of the vertebral fractures,VAS and Oswestry scores were greatly improved in group A and group B as compared with those before t

关 键 词：骨质疏松症 椎体压缩骨折 经皮球囊扩张椎体成形术 唑来膦酸 

分 类 号：R683.2[医药卫生—骨科学]