PVP联合唑来磷酸治疗多椎体骨质疏松性椎体压缩性骨折疗效及对患者腰椎功能及再骨折率的影响  

Effect of PVP combined with zoledronic acid in the treatment of multi-vertebral osteoporotic compression fractures and the influence on lumbar function and re-fracture rate

作　　者：李兴鑫 陈施展 娄延举 张玉恒 贺勇杰 汪丙昂 LI Xing-xin;CHEN Shi-zhan;LOU Yan-ju(Department of Orthopedics,Air Force Hospital of Western Theater Command,Chengdu Sichuan 610000,China)

机构地区：[1]西部战区空军医院骨科,四川成都610000

出　　处：《临床和实验医学杂志》2024年第1期69-73,共5页Journal of Clinical and Experimental Medicine

基　　金：全军后勤科研课题(编号:CKJ21L035)。

摘　　要：目的探究经皮椎体成形术(PVP)联合唑来磷酸治疗多椎体骨质疏松性椎体压缩性骨折(OVCF)的疗效及对患者腰椎功能及再骨折率的影响。方法回顾性分析2016年8月至2020年8月西部战区空军医院收治的136例OVCF患者,按治疗方法不同分为对照组和研究组,各68例。对照组采用PVP联合抗骨质疏松药物治疗,研究组在对照组基础上联合唑来磷酸治疗。比较两组临床疗效、腰椎功能[Oswestry功能障碍指数(ODI)、日常生活活动(ADL)评分]、骨密度、血清生化指标[血钙、血磷、血清骨钙素、骨碱性磷酸酶(NBAP)]及术后再骨折发生情况。结果治疗后两组临床疗效有等级差异,研究组显效率显著高于对照组,差异有统计学意义(P<0.05)。治疗后,两组ODI均低于治疗前,ADL评分均高于治疗前,研究组ODI为(51.76±5.69)分,显著低于对照组[(64.95±5.48)分],ADL评分为(87.19±7.41)分,显著高于对照组[(75.66±7.63)分],差异均有统计学意义(P<0.05)。治疗后,两组腰椎L 1~5和股骨颈骨密度均高于治疗前,研究组腰椎L 1~5和股骨颈骨密度分别为(0.86±0.18)、(0.88±0.15)g/cm^(2),均显著高于对照组[(0.77±0.16)、(0.74±0.17)g/cm^(2)],差异均有统计学意义(P<0.05)。治疗后,两组血钙、血清NBAP均低于治疗前,两组血磷、血清骨钙素均高于治疗前,研究组骨钙素为(10.34±1.45)ng/mL,高于对照组[(8.16±1.56)ng/mL],研究组NBAP为(19.46±2.34)U/L,低于对照组[(25.94±2.38 U/L)],差异有统计学意义(P<0.05)。随访期间,研究组再骨折发生率为0%,显著低于对照组(16.18%),差异有统计学意义(P<0.05)。结论PVP联合唑来磷酸治疗多椎体OVCF疗效满意,患者自理能力提高,骨密度及成骨细胞活性显著增加,无再骨折现象,临床值得推广。Objective To investigate the effect of percutaneous vertebroplasty(PVP)combined with zoledronic acid in the treatment of multi-vertebral osteoporotic vertebral compression fractures(OVCF),and the influence on lumbar function and re-fracture rate.Methods A total of 136 patients with OVCF who were admitted to Air Force Hospital of Western Theater Command from August 2016 to August 2020 were reviewed.According to treatment method,the patients were divided into control group(PVP combined with anti-osteoporosis drugs)and study group(zoledronic acid treatment on the basis of the treatments of control group),with 68 patients in each group.Clinical effects,lumbar function[Oswestry Dysfunction Index(ODI),Activity of Daily Living(ADL)score],bone density,serum biochemical indicators[blood calcium,blood phosphorus,serum bone gla protein,bone alkaline phosphatase(NBAP)]and occurrence of postoperative re-fracture were compared between the two groups.Results After treatment,the markedly effective rate in the study group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).After treatment,ODI scores decreased,and the ADL scores increased in the two groups,the ODI scores of study group were(51.76±5.69)pionts,which were significantly lower than those of the control group[(64.95±5.48)pionts],and the ADL scores were(87.19±7.41)pionts,which were significantly higher than those of the control group[(75.66±7.63)pionts]),the differences were statistically significant(P<0.05).After treatment,bone mineral densities of lumbar spine L 1~5 and femoral neck increased in the two groups,and the bone mineral densities of study group were(0.86±0.18),(0.88±0.15)g/cm^(2),which were significantly higher than those of the control group[(0.77±0.16),(0.74±0.17)g/cm^(2)],the differences were statistically significant(P<0.05).After treatment,the levels of blood calcium and bone alkaline phosphatase decreased,and the levels of blood phosphorus and bone gla protein increased in the two groups,

关 键 词：骨质疏松性椎体压缩骨折 经皮椎体成形 唑来磷酸 腰椎功能 再骨折率 

分 类 号：R687.3[医药卫生—骨科学]