唑来膦酸联合骨水泥技术治疗老年骨质疏松性骨折的疗效分析

Efficacy analysis of zoledronic acid combined with PVP /PKP in the treatment of osteoporotic vertebral compression fractures

目的探讨唑来膦酸（密固达）联合骨水泥技术治疗老年骨质疏松性骨折的临床疗效。方法回顾性分析我科于2010～2011年收治老年骨质疏松性骨折并行PVP/PKP骨水泥技术治疗的病人，20例获得随访，依据PVP/PKP术后是否应用唑来膦酸治疗，分成对照组及实验组。所有病人分别于治疗前和治疗后1年进行股骨近端骨密度测量及疼痛VAS临床评分，评价治疗效果。结果治疗1年后实验组患者股骨近端骨密度明显提高，脊柱骨疼痛症状较对照组得到持续缓解，治疗后1年内无新发骨折。对照组1年期间有脊柱骨性疼痛加重趋势，1例患者术后2月后再次出现新发椎体骨质疏松性骨折。唑来膦酸用药后主要临床不良反应为类流感样反应，包括发热、面红、周身不适等，短期内可缓解，患者均可耐受。结论唑来膦酸联合骨水泥技术治疗老年骨质疏松性骨折效果显著，可明显提高骨质疏松性患者骨密度，预防骨量持续丢失，提高患者生活质量，并有效减轻全身及胸腰部骨性疼痛症状，预防再次骨折发生。应用唑来膦酸给药方便、依从性较好，不良反应轻微、可达到全身系统化治疗，可作为骨质疏松性骨折PVP术后一种良好的辅助治疗措施。

Objective To investigate the therapeutic efficacy of zoledronic acid combined with PVP/PKP in the treatment of osteoporotic vertebral compression fractures. Methods The clinical data of the patients with senile osteoporotic fractures, who received PVP/PKP in our department from January 2009 to March 2012, were retrospectively analyzed. Twenty patients were followed-up. According to with or without the application of zoledronic acid after PVP/PKP, the patients were divided into control group and experimental group. The detection of the bone mineral density （BMD） of the proximal femur and the evaluation of visual analogue scale （VAS） were performed before the treatment and after 1-year treatment, in order to evaluate the therapeutic efficacy. Results After 1-year treatment, BMD of the proximal femur in experimental group improved significantly compared with that in control group. And the pain of th~ spine was continuously alleviated. No new vertebral fractures were observed. The pain of the spine in control group became more severe and 1 patient had new osteoporotic vertebral fractures 2 months after the operation. The main adverse events of zoledronic acid were influenza-like reactions, including fever, red face, and discomfort, which could be alleviated in a short term. And all the syndromes could be tolerated. Conclusion The clinical efficacy of zoledronic acid combined with PVP/PKP in the treatment of osteoporotic vertebral compression fractures is significant. The application can increase BMD significantly in osteoporosis patients, prevent continuous bone mass loss, improve the quality of life, relieve bone pain of the total body and the thoracolumbar vertebrae effectively, and prevent the occurrence of re-fractures. The administration of zoledronic acid is easy, and its compliance is good. The adverse events are slight. It can achieve the purpose of systematic treatment, which is a better adjuvant therapy in osteoporotic fracture patients after PVP/PKP.