单侧椎体成形术联合唑来膦酸治疗老年骨质疏松性椎体压缩骨折的短期疗效

The Efficacy of Zoledronic Acid on the Elderly Patients of Osteoporotic Vertebral Compression Fracture undergoing Percutaneous Vertebroplasty

目的:探讨经皮椎体成形术联合静脉滴注唑来膦酸钠治疗老年骨质疏松性椎体压缩骨折的短期临床疗效。方法:回顾性分析2014年5月-2016年12月在本院行经皮椎体成形术治疗的单节段骨质疏松性胸腰椎椎体压缩骨折的患者67例,根据患者术后是否应用唑来膦酸分为两组,A组22例(经皮椎体成形术后3 d内静脉输注唑来膦酸)和B组45例(单纯行经皮椎体成形术)。随访统计术前、术后1周和术后6个月的疼痛视觉模拟评分(VAS)评估疼痛程度,采用Oswestry功能障碍指数(ODI)评估活动能力。采用双能X线骨密度仪检查术前和术后1年患者腰椎骨密度。住院期间记录患者流感样症状、发热、肌肉骨骼疼痛不适等不良反应发生情况及术后1年脊柱椎体再发骨折情况。结果:术后两组患者的VAS评分、ODI显著降低,其中术后1周VAS评分两组比较差异无统计学意义(P>0.05),而术后6个月VAS评分差异有统计学意义(P<0.05);术后1周、6个月ODI评分A组显著低于B组,差异有统计学意义(P<0.05)。A组患者术后1年内无新发椎体骨质疏松骨折再次入院,复查骨密度较治疗前明显升高,差异有统计学意义(P<0.05)。B组患者随访1年内新发椎体骨质疏松骨折8例,其中邻近椎体3例,非邻近椎体5例,骨密度较A组降低,差异有统计学意义(P<0.05)。但住院期间A组患者输注唑来膦酸后5例出现流感样症状,8例出现低热,3例出现肌肉骨骼疼痛不适不良反应。B组均无其他不良现象出现。术后1年随访期间A组无脊柱再发骨折,B组10例脊柱再发骨折。结论:椎体成形术联合唑来膦酸治疗老年单节段骨质疏松性椎体压缩性骨折能够明显减轻患者疼痛,改善生活质量,预防再次骨折发生,临床效果显著。

Objective:To investigate the clinical efficacy of percutaneous vertebroplasty combined with the application of Zoledronic Acid in the treatment of elderly patients with osteoporotic vertebral compression fractures(OVCF).Method:A retrospective analysis of 67 patients with single osteoporotic thoracolumbar vertebral compression fractures who underwent percutaneous vertebroplasty in our hospital from May 2014 to December 2016 was performed.The patients were divided into two groups,22 cases in group A(intravenous infusion of zoledronic acid within 3 days after percutaneous vertebroplasty)and 45 cases in group B(percutaneous percutaneous vertebroplasty alone).After treatment 1 week and 6 months,the pain visual analogue scale(VAS)and Oswestry disability index(ODI)were evaluated before surgery.Double energy X-ray absorptiometry was used to examine the lumbar spine bone density 1 year after surgery.During the hospitalization,the acute adverse reaction of patients were recorded flu-symptoms,fever,musculoskeletal pain discomfort and others and 1 year followup postoperative vertebral body recurrence of fracture.Result:The VAS scores and ODI of the two groups were significantly decreased after operation.There was no significant difference in VAS scores between the two groups at 1 week postoperatively(P >0.05).There was significant difference in VAS scores at 6 months postoperatively(P<0.05).ODI scores in group A was significantly lower than in group B at 1 week and 6 months,the differences were statistically significant(P<0.05).In group A,no new vertebral osteoporotic fractures were admitted within one year after treatment.The re-examination of bone mineral density was significantly higher than before treatment.The difference was statistically significant(P<0.05).In group B,there were 8 new cases of osteoporotic fractures in the vertebral body at follow-up within 1 year,including 3 cases of adjacent vertebral bodies and 5 cases of non-adjacent vertebral bodies.The bone density was lower than that of group A,the difference was statistically significant(P<0.05).However,inpatients in group A had flu-symptoms of 5 cases,8 cases low fever,and 3 cases experienced musculoskeletal pain discomfort.There were no other unfavorable phenomena in group B.During the 1-year follow-up period,there was no recurrence of fracture in group A and 10 cases of refractures of the spine in group B.Conclusion:Vertebroplasty combined with zoledronic acid in the treatment of elderly patients with single osteoporotic vertebral compression fractures can significantly relieve pain,improve quality of life,prevent secondary fractures,and significant clinical effects.