单节段骨质疏松性腰椎压缩骨折行椎体后凸成形术后应用唑来膦酸注射液治疗的效果观察

Percutaneous kyphoplasty combined with zoledronic acid for the treatment of single segment osteoporotic lumbar vertebralcompression fractures

目的探讨经皮椎体后凸成形术联合唑来膦酸注射液治疗单节段骨质疏松性腰椎压缩骨折的效果。方法回顾性分析2010年3月到2013年3月我院收治的90例绝经后女性单节段腰椎压缩骨折患者临床资料，根据治疗方法的不同将患者分为3组，其中20例行卧床保守治疗（保守组），40例行椎体后凸成形术（手术组），30例行椎体后凸成形术并术后联合唑来膦酸注射液治疗（联合组）。治疗前及治疗后1周、治疗后6个月分别行视觉模拟疼痛评分（VAS）测量，治疗后2年测量腰椎骨密度值，治疗后2年评估各组患者再骨折的发生情况。结果4例患者失访。保守组有3例发生并发症，手术组及联合组患者无并发症发生。联合组及手术组在治疗后1周时VAS分别为（3.0±1.4）、（3.2±1.2）分，较保守组[（8.0±1.1）分]明显减低，差异有统计学意义（P〈0.05）；在治疗后6个月时3组疼痛程度比较差异无统计学意义（P〉0.05）。术后2年联合组椎体骨密度值为（－1.8±0.6），较保守组（－3.1±0.5）及手术组（－2.7±0.3）高，差异有统计学意义（P〈0.05）；术后2年联合组椎体再骨折发生率为3.3%（1/30），明显低于保守组（27.8%，5/18）和手术组（21.1%，8/38），差异有统计学意义（P〈0.05）。结论经皮穿刺椎体后凸成形术联合唑来膦酸注射液治疗老年女性单节段骨质疏松性腰椎压缩骨折安全、有效，可明显缓解疼痛、降低再骨折风险。

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty combined with zoledronic acid for the treatment of single segment osteoporotic vertebral compression fractures（OVCF）.Methods Clinical datas of 90 cases patients with postmenopausal suffered single segment vertebral compression fracture who were treated in Beijing ShiJingshan Hospital of Capital Medical University from March 2010 to March 2013 were retrospectively analyzed.The patienrs were randomly divided into three groups according to the different treatment methods, 20 patients received ＂ bed rest＂ treatment as conservative group, 40 patients were undergone percutaneous kyphoplasty as operation group, 30 patients were given percutaneous kyphoplasty combined with zoledronic acid as combination group.Visual analogue score（VAS） were recorded before treatment and 1 week, 6 months after treatment, and lumbar vertebrae bone mineral density（BMD） was measured before treatment and 2 years after treatment.The subsequent fracture of the vertebrae was analyzed after 2 years of treatment.Results There were 4 patients were not followed up.Three patients in conservative group suffered complications, but no complications were observed in operation group and combination group.The VAS score of the combination group and operation group at 1 week after treatment was significantly different compared with conservative group（（3.0±1.4） points vs.（3.2±1.2） points vs.（8.0±1.1） points, P〈0.05）. At the 6 months after treatment, there were no significant differences among the 3 groups on VAS score（P〉0.05）. Lumbar vertebrae BMD of combination group increased at 2 years after treatment, compared with conservative group and operation group the difference were significantly（（-1.8±0.6） vs.（-3.1±0.5） vs.（-2.7±0.3）, P〈0.05）. The incidence of the subsequent fracture of the vertebrae reduced of combination group, compared with conservative group and operation group the difference were significantly（3.3%（1/30） vs.27.8%（5/18） vs.21.1%（8/38）, P〈0.05）.Conclusion Percutaneous kyphoplasty combined with zoledronic acid for the treatment of OVCF-patients with postmenopausal and single segment fracture is not only safe, effective, but also can obviously relive pain and reduce the risk of subsequent fracture of the vertebrae.