椎体成形术后应用唑来膦酸联合维生素K2治疗老年性椎体压缩骨折

Three-year clinical observation for treating aged vertebral compression fractures combined vertebral plasty with anti-osteoporotic drug

目的观察椎体成形术后应用唑来膦酸联合维生素K2治疗老年性椎体压缩性骨折的3年临床疗效。方法 2013年1月至2015年1月共收治老年性椎体压缩性骨折患者525例,其中女412例,男113例;年龄64~91岁,平均(79±11)岁。所有患者均予CT引导下椎体成形术手术治疗,术后2~4 d给予唑来膦酸静脉输注,同时补充维生素K2以及钙剂、维生素D。获得术前、术后1周和术后3年腰背痛视觉模拟评分(VAS)评分、Oswestry功能障碍指数(ODI),术前及术后3年骨密度、骨代谢指标的数据。采用配对样本t检验的方法对术后与术前,术后不同时间获得的各组数据进行统计分析。结果坚持1年随访为189(36%)人,2年随访为131(25%)人,坚持3年随访的患者为56(10.7%)人,56例中17例为发生再次椎体骨折。经3年随访,患者腰背痛VAS评分(t=3.01)、ODI评分(t=0.98)、骨密度同术前比较均有明显改善,且差异有统计学意义(P<0.05)。骨代谢指标中,骨钙素较术前明显提高(t=5.75),β-CTX较术前显著下降(t=3.06),差异有统计学意义(P<0.05),其他指标变化无统计学差异。结论老年性椎体压缩性骨折患者长期随访治疗的依从性不高。经过椎体成形术后联合多种抗骨质疏松药物3年的干预治疗,可以明显缓解患者临床症状、改善生活质量、促进骨形成、抑制骨吸收、提高骨密度。

Objective To observe the clinical curative effect of treatment for senile vertebral compression fractures by vertebral plasty combine with anti-osteoporosis drug for three years. Methods From January 2013 to January 2015,525 cases of aged vertebral compression fractures were observed,among which412 were females,113 were males; aged from 64 to 91 years,the average age was（ 79 ± 11） years. All the patients accepted percutaneous vertebral plasty surgery guided by CT and C arm X ray,anti-osteoporotic drugs were administrated which included diphosphonate by intravenous infusion in postoperative 2 - 4 d,calcium,vitamin D and vitamin K2 supplements. The lower back pain visual analogue scale（ VAS） and Oswestry disability index（ ODI） were recorded preoperatively,one week postoperatively and at the last follow-up. Bone mineral density and bone metabolism index were recorded preoperatively and at the postoperative three-year follow-up. Paired t test was used to analyze the data of each group obtained at different time after the surgery and before the surgery. Results There were 189（ 36%） patients came back for one year follow-up,131（ 25%） for two-year follow-up,only 56 patients（ 10. 7%） insisted three-year follow-up. Among these 56 patients,17 cases occurred vertebral fracture again. After three-year follow-up,the lower back pain VAS score（ t = 3. 01）, ODI score（ t = 0. 98）,bone mineral density improved compared with preoperative ones,and the differences were statistically significant（ P 〈 0. 05）. As for the bone metabolism index, the osteocalcin（ OC） increased（ t = 5. 75） and the β-CTX decreased（ t = 3. 06） compared with preoperative ones,the differences were significant statistically（ P 〈 0. 05）,while the other indicators showed no statistical difference. Conclusions For the long-term follow-up,the treatment compliance of senile patients with vertebral compression fractures is not optimistic. After three-year treatment of vertebral plasty combined with anti-osteoporotic drug for aged vertebral compression fractures patient,the treatment can obviously relieve patients’ clinical symptoms,improve quality of life,promote bone formation,inhibit bone resorption and improve bone mineral density.