骨质疏松性椎体压缩骨折经皮椎体后凸成形术术后常规疗法联合地舒单抗抗骨质疏松的疗效  

Antiosteoporosis effect of conventional treatment combined with Denosumab after percutaneous kyphoplasty for osteoporotic vertebral compression fractures

作　　者：吴晨阳 顾燚平 邱学力 单华建 高翔[1] 陶理德 张应子 单冰晨[1] 周晓中[1] 白进玉 Wu Chenyang;Gu Yiping;Qiu Xueli;Shan Huajian;Gao Xiang;Tao Lide;Zhang Yingzi;Shan Bingchen;Zhou Xiaozhong;Bai Jinyu(Department of Orthopedics,Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院骨科,苏州215004

出　　处：《中华创伤杂志》2024年第9期787-792,共6页Chinese Journal of Trauma

基　　金：国家自然科学基金(82472515,82102611);江苏省自然科学基金青年基金(BK20210089)。

摘　　要：目的比较骨质疏松性椎体压缩骨折(OVCF)经皮椎体后凸成形术(PKP)术后常规疗法与常规疗法联合地舒单抗抗骨质疏松的疗效。方法采用回顾性队列研究分析2020年9月至2022年9月苏州大学附属第二医院收治的211例OVCF患者的临床资料,均为女性;年龄56~90岁[(71.4±8.1)岁]。术前腰椎骨密度T值为(-2.6±1.0)SD。骨折节段:T_(1)~T_(9)45例,T_(1)0~L_(2)146例,L_(3)~L_(5)69例。174例行单节段手术,25例行2节段手术,12例行3节段及以上手术。按照患者意愿,107例PKP术后每日口服钙剂和活性维生素D(常规治疗组),104例PKP术后在常规治疗基础上联合地舒单抗(地舒单抗治疗组)。比较两组术前及末次随访时腰椎骨密度T值;术前,术后3 d、6个月及末次随访时视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI);术后再骨折发生率。观察两组抗骨质疏松治疗期间可能存在的用药后不良反应。结果患者均获随访12~24个月[(13.5±2.0)个月]。术前地舒单抗治疗组腰椎骨密度T值为(-2.7±1.1)SD,常规治疗组为(-2.5±0.8)SD(P>0.05);末次随访时,地舒单抗治疗组腰椎骨密度T值为(-2.1±1.1)SD,显著高于常规治疗组的(-2.5±0.9)SD(P<0.05)。末次随访时,地舒单抗治疗组腰椎骨密度T值较术前显著增加(P<0.01),而常规治疗组较术前差异无统计学意义(P>0.05)。术前及术后3 d,地舒单抗治疗组VAS分别为(8.5±0.9)分、(2.8±0.8)分,ODI分别为48.7±4.8、25.6±4.0,较常规治疗组的(8.5±1.3)分、(2.8±0.9)分和47.9±7.0、25.9±3.7差异均无统计学意义(P>0.05);术后6个月及末次随访时,地舒单抗治疗组VAS分别为(2.2±0.8)分、(1.7±0.8)分,ODI分别为24.2±3.6、23.2±4.1,显著低于常规治疗组的(2.8±0.9)分、(2.8±1.1)分和26.4±3.2、27.3±4.0(P<0.01)。两组术后各时间点VAS均较术前显著下降(P<0.05),其中地舒单抗治疗组术后VAS持续下降(P<0.05),常规治疗组术后VAS差异无统计学意义(P>0.05)。两组术后各时�Objective To compare the antiosteoporosis effect of conventional treatment and conventional treatment combined with Denosumab after percutaneous kyphoplasty(PKP)for osteoporotic vertebral compression fractures(OVCF).Methods A retrospective cohort study was conducted to analyze the clinical data of 211 patients with OVCF admitted to the Second Affiliated Hospital of Soochow University from September 2020 to September 2022.All the patients were female,aged 56‑90 years[(71.4±8.1)years].The bone mineral density T‑score of the lumbar spine was(-2.6±1.0)SD before operation.Fracture segments included T_(1)‑T_(9) in 45 patients,T_(1)0‑L_(2) in 146,and L_(3)‑L_(5) in 69.Of all,174 patients were treated with single‑segment surgery,25 with two‑segment surgery and 12 with surgery involving three or more segments.According to the wishes of the patients,107 patients were treated with daily oral administration of calcium and active Vitamin D after PKP(conventional treatment group)and 104 patients with Denosumab combined with the conventional treatment after PKP(Denosumab therapy group).The bone mineral density T‑scores of the lumbar spine of the two groups were compared before surgery and at the last follow‑up.The visual analogue scale(VAS)and Oswestry disability index(ODI)before surgery,at 3 days,6 months after surgery,and at the last follow‑up were evaluated and the refracture rate after surgery was detected.Possible adverse effects after medication during anti‑osteoporosis treatment were observed in two the groups.Results All the patients were followed up for 12‑24 months[(13.5±2.0)months].Before surgery,the bone mineral density T‑score of the lumbar spine was(-2.7±1.1)SD in the Denosumab therapy group and(-2.5±0.8)SD in the conventional treatment group(P>0.05).At the last follow‑up,the bone mineral density T‑score of the lumbar spine was(-2.1±1.1)SD in the Denosumab therapy group,significantly higher than(-2.5±0.9)SD in the conventional treatment group(P<0.05).In the Denosumab therapy gr

关 键 词：骨质疏松 脊柱骨折 椎体成形术 地舒单抗 

分 类 号：R580[医药卫生—内分泌] R687.3[医药卫生—内科学]