胸腰椎经皮椎体后凸成形后连续2年应用唑来膦酸预防二次骨折

Two-year postoperative use of zoledronic acid prevents secondary fractures following percutaneous kyphoplasty

背景:研究表明,老年骨质疏松性胸腰椎骨折经皮椎体后凸成形后未行抗骨质疏松治疗,导致其他椎体由于骨密度降低和应力的改变出现二次骨折的发生。目的:分析经皮椎体后凸成形后连续2年应用唑来膦酸预防术后椎体继发骨折的可行性。方法:胸腰椎压缩性骨折老年患者186例经皮椎体后凸成形后根据是否自愿应用唑来膦酸分为试验组(84例)和对照组(102例),对照组给予钙剂及阿法骨化醇治疗,试验组在常规给予钙剂、阿法骨化醇后给予连续2年唑来膦酸治疗。所有患者分别于治疗前及第2次注射唑来膦酸治疗后第2年采用双能X射线吸收法、目测类比评分、Oswestry功能障碍指数(ODI)进行骨密度、疼痛和功能评估,并统计2组再骨折数量。结果与结论:(1)2组用药2年后Oswestry功能障碍指数评分、骨密度、目测类比评分均显著优于治疗前(P<0.05);(2)试验组2年内有1例再骨折发生,对照组有9例再骨折发生,2组比较差异有显著性意义(P<0.05)。(3)结果说明,应用唑来膦酸可以预防老年胸腰椎脆性骨折椎体后凸成形后二次骨折发生,提高远期功能及临床疗效。

BACKGROUND： Percutaneous kyphoplasty is the main treatment for senile osteoporotic thoracolumbar fractures, but increasing number of patients who have not been treated with anti-osteoporosis therapy after operation develop secondary fractures due to decreased bone mineral density and changes of stress. OBJECTIVE： To investigate the feasibility of consecutive 2-year zoledronic acid treatment following percutaneous kyphoplasty for preventing secondary vertebral fracture. METHODS： 186 elderly patients with thoracolumbar compressive fractures were divided into experimental （n=84） and control （n=102） groups based on their willingness to receive zoledronic acid treatment or not after percutaneous kyphoplasty. The experimental group was treated with calcium and alfacalcidol followed by 2 years of zoledronic acid treatment, while only calcium and alfacalcidol treatment was done in the control group. The bone mineral density, pain and function were respectively assessed by dual energy X-ray absorptiometry, visual analogue scale and Oswestry disability index, and the number of refractures was calculated at baseline and at the 2nd year after the second injection of zoledronic acid. RESULTS AND CONCLUSION： The bone mineral density, visual analogue scale and Oswestry disability index scores at 2 years after treatment in both two groups were significantly superior to those at baseline （P 〈 0.05）. The number of refractures in the experimental group （n=l） was significantly less than that in the control group （n=9） （P 〈 0.05）. These results suggest that zoledronic acid can prevent secondary fractures after percutaneous kyphoplasty in the elderly with osteoporotic thoracolumbar fractures, improve long-term function and clinical effectiveness.