唑来膦酸结合骨填充网袋经皮椎体成形术对老年骨质疏松性脊柱骨折患者疼痛与脊柱功能的影响  

Clinic effects of bone-filling mesh bag and percutaneous vertebroplasty combined with postoperative zoledronic acid in elderly patients with osteoporotic vertebral fractures

作　　者：张皓[1] 代东杰 Zhang Hao;Dai Dongjie(Spine Surgery,Chifeng Municipal Hospital,Chifeng,Inner Mongolia 024000,China)

机构地区：[1]赤峰市医院脊柱外科,内蒙古赤峰024000

出　　处：《创伤外科杂志》2024年第10期757-761,共5页Journal of Traumatic Surgery

基　　金：内蒙古自治区卫健委课题项目(202202325)。

摘　　要：目的探究唑来膦酸结合骨填充网袋经皮椎体成形术(PVP)术后对老年骨质疏松性脊柱骨折患者VAS与脊柱功能的影响。方法回顾性分析2022年1月—2022年12月赤峰市医院脊柱外科收治的老年骨质疏松性脊柱骨折患者98例,以治疗方法不同分为对照组(45例)和观察组(49例),两组患者均应用骨填充网袋PVP治疗,即伤椎间隙各方向充分扩张后,置入骨填充网袋及骨水泥进行伤椎复位,术后对照组应用常规抗骨质疏松药物治疗,观察组在对照组基础上联合唑来膦酸(术后3个月应用5 mg唑来膦酸静脉滴注治疗,滴注时间≥15 min,治疗1次)治疗,均持续随访至术后12个月,比较两组患者术前、术后12个月VAS、ODI、椎体解剖学结构、骨密度、脊柱骨质疏松性骨折再发生率及药物不良反应发生率。结果两组患者性别、年龄、BMI、病程、病灶位置比较差异无统计学意义(P>0.05);术前观察组VAS、ODI与对照组比较差异无统计学意义(P>0.05),术后12个月观察组VAS、ODI水平均较对照组低[(0.8±0.2)分vs.(1.2±0.3)分、(23.34±3.45)%vs.(26.65±4.12)%,P<0.05];术前、术后12个月观察组伤椎Cobb角、伤椎前缘高度与对照组比较差异无统计学意义(P>0.05);术前观察组髋部、腰部L 1~L 4骨密度T值水平与对照组比较差异无统计学意义(P>0.05);术后12个月观察组髋部、腰部L 1~L 4骨密度T值水平均较对照组高[(-3.05±0.49)vs.(-3.44±0.53)、(-1.92±0.28)vs.(-2.54±0.47),P<0.05];随访期间观察组脊柱骨质疏松性骨折再发生率为2.04%,与对照组4.44%比较差异无统计学意义(P>0.05);两组患者均未发生严重不良反应,观察组不良反应发生率为30.61%较对照组8.89%高(P<0.05)。结论对老年骨质疏松性脊柱骨折患者骨填充网袋PVP治疗后,在应用常规抗骨质疏松药物基础上,联合应用唑来膦酸可降低患者疼痛程度及ODI评分,改善伤椎解剖学结构,提升其骨密度水平,但会增加不良Objective To explore the clinical effect of bone-filling mesh bag and percutaneous vertebroplasty(PVP)combined with postoperative administration of zoledronic acid in elderly patients with osteoporotic vertebral fractures(OVFs).Methods A retrospective analysis was conducted on 98 elderly patients with OVFs admitted to the Spinal Surgery of Chifeng Municipal Hospital from Jan.2022 to Dec.2022.All patients received PVP based on bone-filling mesh bag(fully expanding the intervertebral space in all directions and inserting bone-filling mesh bags and bone cement for vertebral reduction)and osteoporosis treatment.Patients were divided into control group with conventional anti-osteoporosis drugs(45 cases,21 males and 24 females aged 60-78 years,mean 69.9 years)and observation group with additional intravenous infusion of the zoledronic acid once at 3 months after surgery(5 mg with the infusion time≥15 min;49 cases,19 males and 30 females aged 60-81 years,mean 70.2 years).Both groups were continuously followed up for 12 months.The VAS,Oswestry dysfunction index(ODI),vertebral anatomy,and bone density before and 12 months after surgery were compared between the two groups,as well as the recurrence rate of OVFs and incidence of adverse drug reactions.Results Comparison between two groups revealed no statistically significant difference in gender,age,body mass index,disease duration,or lesion location(all P>0.05),as well as preoperative VAS,ODI,Cobb angle,anterior edge height of the injured vertebrae,T values by bone density of the hip and L 1-4(all P>0.05).At 12 months after surgery,the observation group revealed much lower VAS(0.8±0.2 vs.1.2±0.3)and ODI(23.34%±3.45%vs.26.65%±4.12%,both P<0.05),similar Cobb angle(10.54°±2.84°vs.10.99°±2.36°)and anterior edge height of the injured vertebra(mm,24.24±3.11 vs.23.23±2.96,both P>0.05),and much higher bone density T values at the hip(-3.05±0.49 vs.-3.44±0.53)and the L 1-4 levels(-1.92±0.28 vs.-2.54±0.47,both P<0.05).During the follow-up period,the recurrence rat

关 键 词：脊柱骨折 骨质疏松 骨填充网袋经皮椎体成形术 唑来膦酸 老年 

分 类 号：R687.3[医药卫生—骨科学]