经皮椎体后凸成形术后唑来膦酸治疗骨质疏松性椎体压缩骨折的疗效  

Effect of zoledronic acid for osteoporotic vertebral compression fracture after treatment with percutaneous kyphoplasty

作　　者：周震涛[1] 白进玉 单冰晨[1] 沈忆新[1] 严军[1] 成茂华[1] 徐又佳[1] 周晓中[1] Zhou Zhentao;Bai Jinyu;Shan Bingchen;Shen Yixin;Yan Jun;Cheng Maohua;Xu Youjia;Zhou Xiaozhong(Department of Orthopedics,Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Second Clinical Medical College of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属第二医院骨科,215004 [2]苏州大学第二临床医学院,215000

出　　处：《中华创伤杂志》2020年第9期804-809,共6页Chinese Journal of Trauma

基　　金：江苏省重点研发计划(社会发展)面上项目(BE2019662);苏州市临床重点病种诊疗技术专项项目(LCZX201904)。

摘　　要：目的探讨经皮椎体后凸成形术(PKP)术后应用唑来膦酸治疗骨质疏松性椎体压缩骨折(OVCF)的疗效。方法采用回顾性病例对照研究分析2012年1月—2016年12月苏州大学附属第二医院收治的430例老年OVCF患者临床资料,其中男31例,女399例;年龄52~91岁[(72.8±8.3)岁]。骨折节段:T5~T1082椎,T11~L2389椎,L3~L5173椎。178例PKP术后接受唑来膦酸治疗(唑来膦酸组),252例PKP术后接受基础治疗(基础治疗组)。比较两组术前及术后1年骨密度,比较两组术前、术后3 d及1年视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI),统计两组再骨折发生率、病死率和并发症发生率。结果患者均获随访12~60个月[(27.3±4.6)个月]。术前及术后1年唑来膦酸组腰椎骨密度T值分别为(-2.3±1.5)SD、(-1.2±2.3)SD(P<0.05),基础治疗组分别为(-2.2±1.2)SD、(-2.1±1.1)SD(P>0.05)。术后1年唑来膦酸组骨密度明显优于基础治疗组(P<0.05)。唑来膦酸组术前、术后3 d及术后1年的VAS分别为(8.6±0.8)分、(2.8±0.8)分、(2.1±0.8)分,基础治疗组分别为(8.5±1.1)分、(2.9±0.9)分、(3.0±2.3)分。唑来膦酸组术前、术后3 d及术后1年的ODI分别为48.7±5.3、24.0±2.9、22.3±3.3,基础治疗组分别为48.3±6.1、24.5±3.8、27.6±4.0。术后3 d及1年两组VAS与ODI均较术前明显改善(P<0.05),且术后1年唑来膦酸组VAS与ODI明显低于基础治疗组(P<0.05)。术后2年唑来膦酸组再次骨折发生率为10.1%(18/178),明显低于基础治疗组的16.7%(43/252)(P<0.05)。唑来膦酸组病死率为5.1%(9/178),基础治疗组为6.3%(16/252)(P>0.05)。术后两组均未出现神经损伤、肺栓塞等严重并发症。结论PKP术后联用唑来膦酸能有效提高OVCF患者骨密度、减轻疼痛、促进功能恢复,并有效降低椎体再次骨折发生率。Objective To evaluate the effect of zoledronic acid administration for osteoporotic vertebral compression fracture(OVCF)after treatment with percutaneous kyphoplasty(PKP).Methods A retrospective case-control study was performed on 430 elderly patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from January 2012 to December 2016.There were 31 males and 399 females,with age of 52-92 years[(72.8±8.3)years].Fracture segments were at T5-T10(82 vertebrae),T11-L2(389 vertebrae)and L3-L5(173 vertebrae).In zoledronic acid group(n=178),patients were given zoledronic acid 3 days after PKP surgery.In basic treatment group(n=252),patients were only given basic treatment after PKP surgery.Bone mineral density was measured before operation and one year after operation.Visual analogue scale(VAS)and Oswestry disability index(ODI)were assessed before operation,3 days and one year after operation.Incidence rate of refracture,mortality and complication rate were recorded after operation.Results All patients were followed up for 12-60 months(mean,27 months).Before operation and at postoperative 1 year,the vertebral bone mineral density in zoledronic acid group was(-2.3±1.5)SD and(-1.2±2.3)SD(P<0.05),and that in basic treatment group was(-2.2±1.2)SD and(-2.1±1.1)SD(P>0.05).At postoperative 1 year,the bone mineral density in zoledronic acid group was significantly better than that in basic treatment group(P<0.05).At preoperative 3 days,postoperative 3 days and postoperative 1 year,the VAS was(8.6±0.8)points,(2.8±0.8)points,(2.1±0.8)points in zoledronic acid group,and was(8.5±1.1)points,(2.9±0.9)points,(3.0±2.3)points in basal treatment group;ODI was 48.7±5.3,24.0±2.9,22.3±3.3 in zoledronic acid group,and was 48.3±6.1,24.5±3.8,27.6±4.0 respectively in basal treatment group.The VAS and ODI were significantly reduced in two groups at postoperative 3 days and 1 year compared to those before operation(P<0.05).Moreover,the VAS and ODI in zoledronic acid group were significantly lower than thos

关 键 词：脊柱骨折 骨质疏松 骨折 压缩性 椎体成形术 唑来膦酸 

分 类 号：R687.3[医药卫生—骨科学]