唑来膦酸与阿仑膦酸钠治疗骨质疏松性椎体压缩骨折术后疗效分析

目的探讨唑来膦酸（ZOL）与阿仑膦酸钠（AST）治疗骨质疏松性椎体压缩骨折术后的临床疗效与安全性。方法2012年4月至2014年6月行PKP手术患者73例，随机分为AST组和ZOL组，术后3避行首次给药，所有患者均要求治疗期间补充钙剂与维生素D3，疗程2年。分别评估患者术后、服药后3个月、6个月、12个月、18个月、24个月不同时间短VAS评分、QUALEFFO-41量表评分、骨密度（BMD），并统计两组患者用药前后新发骨折及不良反应例教。结果治疗2年后，两组患者BMD与治疗前比较，差异有统计学意义（P〈0．05），短期两组患者BMD相当，治疗18个月后，ZOL组患者腰椎BMD、髋部BMD均明显高于AST组（P〈0．05）；ZOL与AST均能缓解患者疼痛状况，治疗12个月后，ZOL组患者VAS评分明显低于AST组，差异有统计学意义（P〈0．05）；唑来膦酸与阿仑膦酸钠均能显著改善患者QUALEFFO-41量表评分；ZOL组用药后出现短暂不良反应5例；AST组发生不良反应7例；ZOL组非暴力性骨折3例，AsT组2例。结论唑来膦酸与阿仑膦酸钠均能使骨质疏松性椎体压缩骨折术后患者显著改善功能并减轻疼痛，两者的用药安全性相当，从药物的依从性看唑来膦酸比阿仑膦酸钠为更理想的选择。

Objective To discuss the clinical efficacy and safety of zoledronic acid （ ZOL ） and alendronatc （ AST ） in patients with osteoporotic vertebral compression fractures. Methods A total of PKP patients （ n=73 ） were enrolled in this study. All patients were divided into AST group （ 5mg/year ） and ZOL group （ 70rag/week ） . All patients were given drugs in the first 3 days after surgery, and required calcium supplementation with vitamin D3 during the treatment period.The scores of visual analogue scale （VAS） , QUALEFFO-41 scale, bone mineral density （ BMD ） were measured at 3 months, 6 months, 12 months, 18 months and 24 months after the treatment and the new fractures and adverse reaction cases of two groups were compared before and after treatment. Results After two years＇ treatment, the BMD of the two groups were significantly different （ P〈0.05 ） , and no difference between the two groups of short-term BMD. The BMD of the lumbar vertebrae and hip BMD were significantly higher in the ZOL group than that in the AST group （P〈0.05） after 18 months of treatment. The study also found that zoledronic acid and alendronate can relieve pain in patients （ after 12 months of treatment, P〈0.05, after 24 months of treatment, P〈0.01 ） . After 12 months of treatment, the VAS score of ZOL group was significantly lower than AST group, the difference was statistically significant （ P〈0.05 ） . At the same time, zoledronic acid and alendronate significantly improved the quality of life of patients （ after 6 months of treatment, P〈0.05, after 12 months of treatment, P〈0.01 ） . The proportion of ZOL group which were short-term adverse reactions （ fever, arthralgia and flu-likesymptoms, 5 cases ） was higher than AST group which were mainly gastrointestinal reactions （ 7 cases ） . There were some non-violent fractures in both groups, ZOL group 3 cases, AST group 2 cases. Conclusion Both zoledronic acid and alendronate can improve the function and relieve the pain of patients with osteoporotic vertebral compression fractures. The safety of zoledronic acid and alendronate is similar. In terms of drug compliance, zoledronic acid is a better alternative than alendronate.