经皮穿刺椎体成形同期与非同期联合唑来膦酸治疗骨质疏松性椎体压缩骨折的1年随访比较

Percutaneous vertebroplasty combined with concurrent and non-concurrent use of zoledronic acid in the treatment of osteoporotic vertebral compression fractures: a 1-year follow-up comparison

背景:经皮穿刺椎体成形治疗椎体骨折的过程中,骨水泥注入并不能有效缓解骨质疏松,还需进行抗骨质疏松治疗,而什么时候进行抗骨质疏松治疗目前仍有待研究确定。目的:对经皮穿刺椎体成形同期联合唑来膦酸治疗骨质疏松性椎体压缩骨折与术后应用唑来膦酸进行1年的随访比较分析。方法:纳入骨质疏松性椎体压缩骨折患者60例,A组30例行椎体成形同期联合唑来膦酸治疗,B组30例行椎体成形治疗后1个月应用唑来膦酸治疗。两组术后均给予基础药物钙制剂和维生素D治疗。结果与结论:与治疗前相比,2组患者治疗后的骨折椎体高度增加,Cobb角缩小,目测类比评分和Oswestry功能障碍指数减少,髋部骨密度增加,血清总Ⅰ型胶原氨基端延长肽水平和β-胶原降解产物减少,25羟基维生素D水平上升,血清甲状旁腺素水平变化差异无显著性意义。与非同期组相比,同期组治疗后1个月和1年时目测类比评分与Oswestry功能障碍指数较低,治疗后1年时髋部骨密度值较高,血清总Ⅰ型胶原氨基端延长肽水平和β-胶原降解产物较低,25羟基维生素D水平较高。说明经皮穿刺椎体成形联合基础药物治疗同期联合唑来膦酸治疗,可以有效治疗骨质疏松性椎体压缩骨折,恢复骨折椎体高度,缓解疼痛,提高骨密度,改善骨代谢,适合临床推广。

BACKGROUND:For osteoporotic vertebral compression fractures,bone cement injection alone cannot effectively relieve osteoporosis.Therefore,anti-osteoporosis treatment is necessary,and the timing for anti-osteoporosis treatment is still pending.OBJECTIVE:To compare the clinical outcomes of percutaneous vertebroplasty combined with concurrent and non-concurrent use of zoledronic acid in the treatment of osteoporotic vertebral compression fractures based on a 1-year follow-up visit.METHODS:Sixty patients with osteoporotic vertebral compression fractures were enrolled,30 cases in group A who were treated with vertebroplasty combined with zoledronic acid,while the other 30 cases in group B who were treated with vertebroplasty and given zoledronic acid Injection at 1 month after vertebroplasty.Both groups were given calcium preparation and vitamin D treatment.RESULTS AND CONCLUSION:Vertebral height and Cobb angle in the two groups were significantly improved after treatment compared with the baseline.Visual Analogue Scale scores and Oswestry disability index were reduced in the two groups after treatment compared with the baseline.Increased bone mineral density of the hip,reduced levels of serum procollagen type I carboxy-terminal extension peptide(PINP)andβ-C-terminal cross-linking telopeptide of type I collagen(β-CTX),and increased 25-hydroxy vitamin D were also found in the two groups after treatment compared with the baseline.However,there was no significant difference in the serum level of parathyroid hormone before and after treatment.Compared with the non-concurrent group,the concurrent groups had lower scores on the Visual Analogue Scale scores and Oswestry disability index at 1 month and 1 year after treatment,higher bone mineral density of the hip,lower levels of PINP andβ-CTX,and higher level of 25-hydroxy vitamin D at 1 year after treatment.These findings indicate that percutaneous vertebroplasty combined with concurrent zoledronic acid can effectively treat osteoporotic vertebral compression fractures,restore vertebral height,relieve pain,elevate bone mineral density and improve bone metabolism,which is a method available for clinical use.