小剂量骨水泥椎体后凸成形联合唑来膦酸治疗骨质疏松椎体压缩性骨折

Percutaneous kyphoplasty with low-dose bone cement in combination with zoledronic acid for treatment of osteoporotic vertebral compression fractures

背景:经皮椎体后凸成形治疗骨质疏松性压缩骨折的效果已获肯定,但仍旧存在骨水泥漏、再骨折等相关并发症,缺乏骨质疏松的后期治疗。目的:探讨临床小剂量骨水泥椎体后凸成形联合唑来膦酸治疗骨质疏松椎体压缩性骨折后的骨密度、椎体高度及腰背痛疼痛改善情况。方法:将80例骨质疏松椎体压缩性骨折患者随机分2组治疗,试验组(n=40)进行小剂量骨水泥椎体后凸成形联合唑来膦酸治疗,对照组(n=40)进行常规剂量骨水泥椎体后凸成形治疗,记录治疗前、治疗后3 d及末次随访的目测类比评分、椎体高度和Cobb角改善情况,治疗后1年复查骨密度及再发骨折情况。结果与结论:(1)目测类比评分:两组治疗3 d、末次随访的目测类比评分均显著低于治疗前(P<0.05),两组间比较差异无显著性意义;(2)椎体高度和Cobb角:两组治疗3 d、末次随访的椎体高度和Cobb角均较治疗前明显改善(P<0.05),两组间比较差异无显著性意义;(3)骨密度:试验组治疗后1年的骨密度明显高于治疗前(P<0.05),对照组治疗前后无明显变化;(4)再发骨折情况:试验组1例出现邻近椎体骨折,对照组5例出现邻近椎体骨折;(5)结果表明:小剂量骨水泥椎体后凸成形联合唑来膦酸治疗骨质疏松椎体压缩性骨折在有效缓解疼痛、恢复椎体高度的同时可显著提高骨密度,减少相邻节段骨折的发生。

BACKGROUND： In recent years, percutaneous kyphoplasty （PKP） has been widely used in the treatment of osteoporotic vertebral compression fractures, but there are still some complications, such as bone cement leakage and re-fractures, and a lack of follow-up treatment.OBJECTIVE： To investigate the effect of PKP with low-dose bone cement in combination with zoledronic acid on bone mineral density （BMD）, vertebral height and low back pain after osteoporotic vertebral compression fractures.METHODS： Eighty patients with osteoporotic vertebral compression fractures were equally randomized into test group （treated with PKP with low-dose bone cement in combination with zoledronic acid） and control group （treated with PKP with conventional bone cement）. Visual analog scale score, vertebral height, and Cobb angle were detected before, at 3 days after treatment and at the final follow-up visit. BMD and re-fracture incidence were reviewed 1 year after treatment.RESULTS AND CONCLUSION： Visual analog scale scores, vertebral height, and Cobb angle were significantly improved in both groups at 3 days after treatment and at the final follow-up visit （P 〈 0.05）; however, there was no statistical difference between the test and control groups. One year after treatment, the BMD value was significantly increased in the test group （P 〈 0.05）, but showed no change in the control group as compared with the pretreatment.Postoperatively adjacent vertebral fractures were found in one case of the test group, and five cases in five cases of the control group. These findings indicate that PKP with low-dose bone cement in combination of zoledronic acid can effectively relieve pain symptoms, restore the height of the vertebral body, significantly increase BMD value and reduce the incidence of adjacent vertebral fractures in patients with osteoporotic vertebral compression fractures.