甲状旁腺素1-34联合经皮椎体后凸成形术治疗骨质疏松性椎体骨折疗效

Clinical effects of parathyroid hormone 1-34 combined with percutaneous kyphoplasty on osteoporotic vertebral compression fracture

目的比较经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)联合与不联合甲状旁腺素(1-34)(parathyroid hormone 1-34,PTH 1-34)治疗骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的临床疗效。方法对山西大医院2012年5月到2013年12月期间收治符合纳入标准的应用PKP治疗的138例OVCF患者,术后采用数字法随机按2∶1分为PTH组和对照组,PTH组为PKP术后口服钙剂1 000 mg/d及维生素D 400 IU/d并皮下注射PTH 1-34 20μg/d,对照组为PKP术后单纯口服钙剂1 000 mg/d及维生素D 400 IU/d。手术前,术后3 d、1年和术后2年分别记录患者Oswestry功能障碍指数(Oswestry disability index,ODI)、视觉模拟评分(visual analogue scale,VAS)、椎体前缘高度、中间高度、椎体后凸角测量(Cobb angle,Cobb角)、骨密度检测值、术后临近椎体再骨折情况。同时应用上述指标评价PTH 1-34对于OVCF的治疗效果。结果随访结束后获得85例完整资料,其中PTH组43例,对照组42例,其中PTH组术前、术后3 d、术后1年、术后2年的VAS分别为7.83±0.81、2.47±0.88、1.49±0.85、1.31±0.85分;对应的ODI指数分别为74.22±3.74、22.72±2.59、20.41±1.99、19.49±2.13。两组术后3 d、术后1年、术后2年VAS及ODI均较术前明显改善(P<0.05);术后1年及术后2年,两组VAS及ODI比较,差异均具有统计学意义(P<0.05)。两组手术前后椎体前缘高度、中间高度、Cobb角测量差异均具有统计学意义(P<0.05);术后1年及术后2年两组间比较椎体前缘高度、中间高度、Cobb角测量差异均具有统计学意义(P<0.05)。PTH组术后1年及术后2年腰椎L1-4骨密度测定值为(0.780±0.038)g/cm2、(0.810±0.038)g/cm2,明显比术前(0.705±0.040)g/cm2高(P<0.05)。组间比较PTH组术后1年及术后2年腰椎骨密度较对照组明显增高(P<0.05);PTH组术后1年股骨颈骨密度与对照组比较,差异无统计学意义(P>0.05);术后2年股骨颈骨密度较对照组明显增高(P<0.05)。PTH组术后再骨折4例,对照组术后再骨折8例。结论 PKP治疗OVCF具有微创、迅速缓解疼痛等优点,术后应用PTH 1-34治疗可有效改善患者生活质量,提高骨密度,减少术后椎体再骨折风险。

Objective To compare the clinical effects of percutaneous kyphoplasty （PKP） c, ombined and not combined with parathyroid hormone 1-34 （PTH 1-34） on osteoporotic vertebral compression fracture （OVCF）. Methods A total of 138 OVCF patients who underwent PKP therapy in Shanxi Dayi Hospital affiliated to Shanxi Medical University were recruited. They were randomly divided into parathyroid hormone （PI＇H） group and control group as the ratio of 2： 1. PTH group received daily oral 1 000 mg calcium and 400 IU vitamin D together with subcutaneous injection of PTH 1-34 at dose of 20 μg/d, while the control group took orally the same amount of calcium and vitamin D. The patients＇ Oswestry disability index （ ODI）, visual analogue scale （VAS）, anterior vertebral height, middle vertebral height, Cobb angle, bone mineral density （BMD） , adjacent vertebral refracture, were recorded before operation and after 3 days, 1 year and two years of surgery. Results Eighty five cases with complete information remained after two years＇ follow-up, including 43 eases in PTH group and 42 cases in the control group. VAS of pre-operation, 3 days, 1 year, and 2 years after operation in PTH group were 7.83 ±0. 81, 2.47 ±0. 88, 1.49 ±0. 85, and 1.31 ±0. 85, respectively. Correspondingly, ODI were 74. 22 ±3.74, 22. 72±2. 59, 20.41 ± 1.99, and 19.49±2. 13, respectively. VAS and ODI were significantly improved after 3 days, 1 year, and 2 years of operation in the two groups （P 〈 0. 05 ）. And they were significantly different between the two groups after 1 year and 2 years of operation （ P 〈 0. 05 ）. Significant difference in anterior vertebral height, middle vertebral height, and Cobb angle were seen between pre-operation and post-operation both in the two groups, and between the two groups after 1 year and 2 years of snrgery. Bone mineral density of lumbar vertebrate after 1 year and 2 years of surgery were （0. 780 ±0. 038） g/cm2 and （0. 810 ±0. 038） g/cm2, respectively, significantly improved compared with pre-operation （0. 705 ±0. 040） g/cm2. BMD of lumbar vertebrate was higher in PTH group than control group alter 1 year and 2 years of surgery. BMD of femoral neck in PTH group was higher than control group in 2 years but without significance alter 1 year. Refracture occurred in 4 cases in PTH group, and in 8 cases in the control group. Conclusions Treatment of OVCF with PKP was minimally invasive and could induce rapid pain relief. Postoperative PTH 1-34 treatment could effectively improve the life quality of patients, increase bone density and reduce the risk of vertebral refractures.