术后早期应用唑来膦酸对腰椎融合的影响

Eeffects of early used zoledronic acid on lumbar spinal fusion

目的：探讨唑来膦酸对骨质疏松患者腰椎融合术后植骨融合的影响。方法回顾性分析2010年1月至2011年3月因腰椎间盘退变性疾病合并绝经后骨质疏松症患者的病例资料共36例。患者均采用后路腰椎板切除减压、椎间及后外侧植骨融合、椎弓根钉棒内固定术。术后1～2周给予唑来膦酸注射液5mg静脉滴注，同时每天补充元素钙1000 mg和维生素D3400 U。比较术前与术后3、6、12个月时功能障碍指数（ ODI ）评分与骨转换生化标志物变化。比较术前与术后12个月骨密度变化。分析随访期末时的植骨融合情况。结果36例患者均获得随访，平均年龄（63.18±6.97）岁。术前ODI评分平均为（38.36±5.95）分，术后3个月为（14.36±5.22）分，术后6个月为（9.00±6.07）分，术后12个月为（9.18±6.65）分。术后各时间点ODI评分与术前相比差异均有统计学意义（均P＜0.05）。术后3、6个月ODI评分持续下降，6个月达平台期，与12个月相比差异无统计学意义（ P＞0.05）。骨转换生化标志物血清β-Ⅰ型胶原交联羧基末端肽（β-CTX）、Ⅰ型原胶原氨基端前肽（PINP）术后3个月显著降低（P＜0.05），6、12个月时缓慢升高，但均保持在绝经后正常范围内。术前髋部和股骨颈骨密度为（0.721±0.16）和（0.687±0.19） g/cm^2，术后12个月提高至（0.746±0.16）和（0.714±0.17） g/cm^2（P＜0.05）。34例患者获得坚实融合，2例未融合，融合率为94.4％（34/36）。结论唑来膦酸抗骨质疏松作用显著，骨质疏松患者术后早期应用唑膦酸对腰椎融合无不利影响。

Objective To explore the effect of zoledronic acid on lumbar spinal fusion for patients with osteoporosis .Methods From January 2010 to March 2011, 36 women with postmenopausal osteoporosis suffering from lumbar disc degenerative diseases were analyzed .All patients underwent posterior lumbar discectomy , decompression , intervertebral and posterolateral bone graft fusion and pedicle screw fixation .One to two weeks after surgery , all patients received 5 mg zoledronic acid infusion plus daily element calcium 1000 mg and vitamin D3 400 IU.Compare the ODI scores and biochemical markers of bone turnover before and 3 months、 6 months and 12 months after surgery .The changes of bone mineral density before and 12 months after treatment were also compared .The solid fusion rate was analyzed . Results Thirty-six patients with an average age of 63.18 ±6.97 were followed .The ODI scores of pre-operation, 3 months , 6 months and 12 months after operation were 38.36 ±5.95 , 14.36 ±5.22 , 9.00 ±6.07 and 9.18 ±6.65 .Significant difference was achieved regarding to the ODI scores at any follow-up time compared with that of pre-operation （P〈0.05）.The ODI scores declined obviously 3 months and 6 months after surgery, reaching to a plateau at 6 months,showing no significance compared with the scores of 12 months after surgery .The biochemical markers of bone turnover β-C-terminal crosslink of type Ⅰcollagen （β-CTX） , Amino-terminal propeptide of type I collagen （ PINP） decreased sig-nificantly at 3 months （ P〈0.05 ） , then increased slightly , remaining in the normal range of post menopause 6 and 12 months after surgery.Bone mineral density of hip and femoral neck were improved from （0.721 ±0.16） and （0.687 ± 0.19） g/cm^2 to （0.746 ±0.16） and （0.714 ±0.17） g/cm^2 （P〈0.05）.Thirty-four patients achieved solid fusion, with a fusion rate of 94.4%（34/36）.Conclusion The anti-osteoporosis efficacy of zoledronic acid was significant and no negative effect was observed for lumbar spinal fusion .