高黏度骨水泥经皮椎体成形术联合唑来膦酸注射液治疗骨质疏松性椎体压缩骨折老年患者的疗效

Effect of percutaneous vertebroplasty with high viscosity bone cement combined with zoledronic acid injection on elderly with osteoporotic vertebral compression fractures

目的探讨高黏度骨水泥经皮椎体成形术联合唑来膦酸注射液治疗骨质疏松性椎体压缩骨折老年患者的临床疗效。方法选取88例骨质疏松性椎体压缩骨折老年患者，按照随机数字表法分为观察组与对照组，每组44例。对照组行单纯高黏度骨水泥经皮椎体成形术，观察组术后联合唑来膦酸注射液治疗。比较两组手术前及术后不同时段（术后1周、3个月、6个月、1年）疼痛（VAS评分）、椎体骨密度（BMD值）、椎体功能（ODI评分）及并发症、不良反应发生率，同时比较两组术后1、2年骨折再发生率。结果术前及术后1周两组VAS评分、椎体BMD值、ODI评分比较差异未见统计学意义（P〉0.05）。术后3个月、6个月、1年，观察组VAS评分、ODI评分低于对照组，椎体BMD值高于对照组（P〈0.05）。两组术后均未发生骨水泥渗漏、脊髓神经压迫症状、硬膜外血肿等并发症，观察组静脉滴注唑来膦酸注射液后不良反应发生率为27.27%（12/44），但均为轻度及一过性，未给予特殊处理，24～48 h内自动消退。观察组术后1年骨折再发生率（2.27%）与对照组（9.09%）比较差异未见统计学意义（P〉0.05），术后2年骨折再发生率（4.55%）低于对照组（20.45%，P〈0.05）。结论高黏度骨水泥经皮椎体成形术联合唑来膦酸注射液治疗骨质疏松性椎体压缩骨折老年患者疗效显著，可有效缓解患者疼痛，增加椎体骨密度，有利于改善患者椎体功能，降低骨折再发生率。

Objective To investigate the clinical efficacy of percutaneous vertebroplasty with high viscosity bone cement combined with zoledronic acid injection on eldly with osteoporotic vertebral compression fractures. Methods Eighty-eight elderly cases of osteoporotic vertebral compression fractures were randomly divided into observation group and control group, with 44 cases in each group. The control group was treated by percutaneous vertebroplasty with high viscosity bone cement, and the obser- vation group was treated by zoledronic acid injection after operation combind with percutaneous rvertebro- plasty with high viscosity bone cement. The pain （VAS score）, vertebral body bone mineral density （BMD）, vertebral function （ODI score）, complications and incidences of adverse reactions were com- pared between the two groups before and different time after operation （1 week, 3 months, 6 months, 1 year after operation）. At the same time, the rates of fracture recurrence were compared between the two groups at 1 year and 2 years after operation. Results There were no significant differences in the VAS score, the BMD value of the vertebral body or the ODI score between the two groups before and 1 week after the operation （ P 〉 0. 05 ）. After 3 months, 6 months and 1 year of the operation, the VAS score and ODI score of the observation group were lower than those of the control group, and the BMD value of the vertebral body was higher than that of the control group （ P 〈 0. 05 ）. There were no complications such as cement leakage, spinal nerve compression, epidural hematoma or others in the two groups. The incidence of adverse reactions in the observation group after intravenous infusion of zoledronic acid injection was27.27% （ 12/44）, but all were mild and transient. Without special treatment, the auto regression was a- chieved within 24 -48 h. There were no significant difference in the 1-year fracture recurrence rate be- tween the observation group （2. 27% ） and the control group （9.09%, P 〉 0. 05 ）. The 2-year recur- rence rate of fracture in the observation group （4. 55% ） was lower than that in the control group （20. 45%, P 〈 0. 05 ）. Conclusions The efficacy of percutaneous vertebroplasty with high viscosity bone cement combined with zoledronic acid injection on elderly with osteoporotic vertebral compression fractures is significant. It can effectively relieve the pain of the patients, increase the bone mineral densi- ty, improve the function of the vertebral body and reduce the rate of fracture reoccurrence.