椎体后凸成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折的临床疗效

Therapeutic effects of percutaneous kyphoplasty combined with zoledronic acid injection on osteoporotic vertebral compression fracture

目的探讨椎体后凸成形术(percutaneous kyphoplasty,PKP)联合唑来膦酸注射液治疗骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法回顾性分析住院治疗并采用PKP治疗的老年骨质疏松性单椎体压缩骨折患者65例,其中术后输注唑来膦酸注射液组28例(A组)与未输注唑来膦酸注射液组37例(B组)。分别于术前、术后1周、3个月、1年、2年随访,比较2组患者的疼痛视觉模拟评分(visual analogue scale,VAS)、日常生活自理能力评分(activity of daily life,ADL)及椎体压缩性骨折的再发生率,采用多因素回归分析PKP术后再发骨折的危险因素。结果 PKP及唑来膦酸均可缓解缓解患者OVCFs引起的疼痛;在OVCFs发生后,PKP对于疼痛的缓解迅速而有效,而唑来膦酸对于患者疼痛的减轻特别是长时间维持及减轻有显著的效果。术后1年时A组患者椎体压缩性骨折的再发生率与B组比较,差异无统计学意义(P>0.05);术后2年时A组患者椎体压缩性骨折的再发生率明显低于B组(P<0.05);多因素回归分析显示术后再骨折与患者体重指数、骨密度、骨水泥注入量、是否应用唑来膦酸有关,而与年龄、性别、骨水泥渗漏情况、病椎部位及病椎前缘恢复度无关。结论 PKP联合唑来膦酸注射液在治疗骨质疏松性椎体压缩骨折中可缓解患者疼痛,改善生活质量,同时又是减少椎体再发骨折的有效预防措施。

Objective To observe the therapeutic effects of percutaneous kyphoplasty（ PKP） combined with zoledronic acid injection on osteoporotic vertebral compression fracture（ OVCF）. Methods A retrospective analysis about 65 elderly patients with OVCF who underwent PKP was performed,28 patients of whom were treated with PKP combined with zoledronic acid（ group A）,however,the other 37 patients were treated by PKP only（ group B）. The visual analogue scale（ VAS）,activity of daily life（ ADL）,recurrence rate of compression fracture of vertabral body were observed and compared between two groups,following up at 1 week,3 months,1 year,2 years after the operation. Moreover the risk factors influencing relapse rate of bone fracture after PKP were evaluated by multiple factor regression analysis. Results Both PKP and zoledronic acid could relieve the pains caused by OVCFs. After OVCFs,PKP could effective and quickly relieved the pains,however,zoledronic acid could relieve the pains and keep the efficiency effectively. There was no significant difference in the recurrence rate of compression fracture of vertabral body at 1 year after operation between group A and group B（ P 〈0. 05）. However the recurrence rate at 2 years after operation in group A was significantly lower than that in group B（ P 〈0. 05）. The multiple factor regression analysis showed that the recurrence of bone fracture after operation was correlated to patient＇s body mass index（ BMI）,bone mineral density,bone cement volume,application of zoledronic acid,however,which was not related with patient＇s age,sex,leakage state of bone cement,position of vertebral fracture and recovery degree of vertebral fracture anterior border. Conclusion PKP combined with zoledronic acid injection in treatment of OVCF can relieve patient＇s pain,improve life quality,meanwhile,which is an effective protective measure to decrease recurrence of vertebral body fracture.