PVP结合药物治疗骨质疏松性椎体压缩性骨折

Percutaneous vertebroplasty combined with anti-osteoporosis drugs for the treatment of osteoporotic vertebral compressive fractures

目的探讨椎体成形术(PVP)结合药物治疗老年骨质疏松性椎体压缩性骨折(OVCF)的疗效。方法 27例(40椎)OVCF患者行PVP术后,给予鲑鱼降钙素、活性维生素D和钙剂治疗(治疗组),18例(28椎)患者术后拒绝或无法行药物治疗(对照组),两组患者分别于术后0、24和48周测量股骨颈和腰椎骨密度。应用视觉模拟疼痛评分(VAS),对患者疼痛进行评价,同时观察其并发症。结果术后0和24周,两组患者股骨颈和腰椎骨密度值,差异无统计学意义。与对照组比较,术后48个周治疗组患者股骨颈和腰椎骨密度值升高(P<0.05)。术前、术后0周和术后24周,两组患者VAS评分,差异无统计学意义;与对照组比较,术后48周治疗组患者VAS评分降低(P<0.05)。末次随访时,治疗组5例(18.5%)出现邻近椎体或其它部位骨折,对照组出现5例(27.7%)。结论 PVP结合药物治疗OVCF,能阻止其股骨颈和腰椎骨密度降低,缓解疼痛,降低再骨折发生率。

Objective To investigate the clinical efficacy of percutaneous vertebroplasty （PVP） combined with anti-osteoporosis drug treatment for osteoporotie vertebral compressive fractures （OVCF）. Methods Twenty-seven patients （40 vertebra） with OVCF were undergone PVP and administered ealeitonin, vitamin D, and calcium after the operation （Treatment group）. Eighteen patients （28 vertebra） refused or could not receive any drugs after the operation （ Control group）. Bone mineral density （BMD） of the femoral neck and the lumbar vertebrae was measured on O, 24, and 48 weeks after PVP. All patients were evaluated with visual analogue scale （VAS） pre- and post-PVP. Complications were observed. Results There was no statistical difference of BMDs of the femoral neck and the lumbar vertebrae between the two groups on 0 and 24 weeks after PVP. BMDs of the femoral neck and the lumbar vertebrae in patients of the treatment group increased significantly on 48 weeks, comparing with those in Control group （P 〈 0.05）. There was no statistical difference of VAS scale between the two groups on 0 and 24 weeks follow-up. The VAS scale in patients of Treatment group decreased on 48 weeks after PVP, comparing with the control group （P 〈 O. 05 ）. At the last follow-up, neighborhood vertebral compression fracture occurred in 5 cases （18.5%） in Treatment group, whereas 5 cases （27.7%） occurred in Control group. Conclusion PVP combined with anti-osteoporosis drug treatment prevented reduction of BMD of the femoral neck and the lumbar vertebrae. It could also release the pain and reduce the re-fracture rate.