骨水泥联合唑来膦酸修复骨质疏松性椎体压缩骨折

Bone cement combined with zoledronic acid to repair osteoporotic vertebral compression fractures

背景:经皮椎体成形注射骨水泥治疗骨质疏松性椎体压缩骨折可迅速缓解疼痛症状,增加椎体强度,但由于骨质疏松的存在常出现椎体再发骨折情况。目的:观察经皮椎体成形注射骨水泥联合应用抗骨质疏松症药物唑来膦酸治疗骨质疏松性椎体压缩骨折的疗效。方法:纳入6例骨质疏松性椎体压缩骨折患者,其中男2例,女4例,年龄60-86岁,椎体骨折部位包括T12-L4,均进行椎体成形注射聚甲基丙烯酸甲酯骨水泥治疗,并于骨水泥注射后4周静脉滴注唑来膦酸(100 m L∶5 mg)抗骨质疏松治疗,30滴/min,1次/年,连续给药2年。定期影像学检查2年,观察椎体压缩性骨折的临床疗效、骨密度及邻近椎体再发骨折情况。结果与结论:骨水泥注射后48 h,6例患者疼痛症状明显缓解。随访2年,6例患者骨折均愈合,无椎体骨折延迟愈合或不愈合,未出现骨水泥渗漏、神经根卡压、硬膜受累、针口或切口感染及肺栓塞等并发症;骨密度均较治疗前明显升高(P<0.05),无邻近椎体再发骨折情况。表明经皮椎体成形注射骨水泥联合应用抗骨质疏松症药物唑来膦酸治疗骨质疏松性椎体压缩骨折,可明显缓解疼痛,提高椎体稳定性及骨密度,减少相邻椎体再发骨折。

BACKGROUND： Percutaneous vertebroplasty with bone cement injection for osteoporotic vertebral compression fractures can quickly relieve pain and increase vertebral strength, but vertebral re-fractures often occur because of osteoporosis. OBJECTIVE： To investigate the therapeutic effect of percutaneous vertebroplasty with bone cement injection combined with zoledronic acid in the treatment of osteoporotic vertebral compression fractures. METHODS： Six patients with osteoporotic vertebral compression fractures were enrolled, including two males and four females, aged 60-86 years. These patients with T12-L4 vertebral fractures underwent percutaneous vertebroplasty with polymethyl methacrylate acrylate bone cement treatment. At 4 weeks after bone cement injection, all patients were administrated with intravenous injection of zoledronic acid（100 m L： 5 mg） as anti-osteoporosis treatment, 30 drops per minute, once a year, for consecutive 2 years. The 2-year periodic imaging was performed to observe the clinical efficacy on vertebral compression fractures, bone density and adjacent vertebral fractures. RESULTS AND CONCLUSION： At 48 hours after bone cement injection, pain symptoms were relieved in the six cases. At the end of 2-year follow-up, fractures healed in all the six cases without delayed union or nonunion, and there was no bone cement leakage, nerve root compression, dural involvement, needle opening or wound infection and pulmonary embolism; the bone density was significantly higher than that before treatment（P〈0.05）,and no adjacent vertebral fractures occurred. These findings indicate that the percutaneous vertebroplasty with bone cement injection combined with zoledronic acid can significantly relieve pain, improve vertebral stability and bone density, and reduce the incidence of adjacent vertebral fractures in patients with osteoporotic vertebral compression fractures.