唑来膦酸对骨质疏松性胸腰椎爆裂性骨折患者骨水泥强化椎弓根螺钉内固定术后相邻椎体骨密度及骨代谢的影响  

Effects of Zoledronic Acid on Bone Mineral Density and Bone Metabolism of Adjacent Vertebral Bodies in Patients with Osteoporotic Thoracolumbar Burst Fractures after Short Segment Bone Cement-augmented Pedicle Screw Internal Fixation

作　　者：李坤[1] 张鹏[1] 康立星[1] 高彬 LI Kun;ZHANG Peng;KANG Li-xing;GAO Bin(Department of Orthopedics,People's Hospital of Langfang City,Langfang,Hebei 065000,China;Department of Orthopedics,the 81 Group Army Hospital of PLA,Zhangjiakou,Hebei 075000,China)

机构地区：[1]廊坊市人民医院骨科,河北廊坊065000 [2]解放军陆军第八十一集团军医院骨科,河北张家口075000

出　　处：《临床误诊误治》2021年第10期25-29,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究重点课题计划项目(20201608)。

摘　　要：目的探讨唑来膦酸对骨质疏松性胸腰椎爆裂性骨折患者骨水泥强化椎弓根螺钉内固定术后相邻椎体骨密度及骨代谢的影响。方法选取2018年4月—2019年8月收治的64例骨质疏松性胸腰椎爆裂性骨折,根据术后抗骨质疏松治疗方法的不同分为观察组和对照组,每组32例。两组均行骨水泥强化椎弓根螺钉内固定术,且术后予以基础抗骨质疏松治疗,观察组在此基础上联合唑来膦酸治疗。比较两组手术前后Oswestry功能障碍指数(ODI)评分、上下相邻椎体骨密度,以及血清骨特异性碱性磷酸酶(BAP)和β-胶原降解产物(β-CTx)水平。观察两组术后并发症及药物相关不良反应发生情况。结果术后6、12个月,两组ODI评分均低于术前,且观察组低于对照组(P<0.01)。术后12个月,观察组相邻上位及下位椎体骨密度均较术前升高,且相邻上位椎体骨密度高于对照组(P<0.05,P<0.01)。术后6个月,观察组BAP与β-CTx水平均较术前和对照组降低(P<0.05,P<0.01)。观察组术后相邻椎体继发骨折发生率低于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论唑来膦酸可有效增加骨质疏松性胸腰椎爆裂性骨折患者术后相邻椎体骨密度,改善骨代谢,有利于术后功能恢复,还能降低相邻椎体继发骨折的风险,也未增加药物相关不良反应。Objective To investigate effects of Zoledronic Acid on bone mineral density and bone metabolism of adjacent vertebral bodies in patients with osteoporotic thoracolumbar burst fractures after short segment bone cement-augmented pedicle screw internal fixation.Methods A total of 64 patients with osteoporotic thoracolumbar burst fractures admitted between April 2018 and August 2019 were selected and divided into observation group(n=32)and control group(n=32)according to the different methods of postoperative anti-osteoporosis treatment.Both groups were treated with short segment bone cement-augmented pedicle screw internal fixation and basic anti-osteoporosis treatments were all given after operation.Observation group was supplemented with Zoledronic Acid.In two groups,Oswestry dysfunction index(ODI)score,bone mineral density(BMD)of adjacent upper and lower vertebral bodies,serum levels of bone specific alkaline phosphatase(BAP)andβ-collagen degradation products(β-CTx)before and after operation were compared,and incidence rates of postoperative complications and drug-related adverse reactions were observed.Results After operation for 6 and 12 months,ODI scores were significantly lower than those before operation in two groups,and the scores in observation group were significantly lower than those in control group(P<0.01).After operation for 12 months,BMD values of adjacent upper and lower vertebral bodies were significantly higher than those before operation in observation group,and the BMD value of adjacent upper vertebral bodies in observation group was significantly higher than that in control group(P<0.05,P<0.01).After operation for 6 months,levels of BAP andβ-CTx in observation group were significantly lower than those before operation in the same group and in control group(P<0.05,P<0.01).Incidence rate of secondary fractures of adjacent vertebral bodies in observation group was significantly lower than that in control group(P<0.05).There was no significant difference in incidence rate of adverse reactions b

关 键 词：骨质疏松性骨折 脊柱骨折 唑来膦酸 椎弓根螺钉内固定术 骨密度 骨特异性碱性磷酸酶 

分 类 号：R687.3[医药卫生—骨科学]