椎弓根固定联合伊班膦酸钠对胸腰段脊柱爆裂骨折的疗效影响

Short-term and long-term effects of pedicle screw fixation combined with ibandronate on thoracolumbar burst fractures

目的探讨椎弓根固定联合伊班膦酸钠对胸腰段脊柱爆裂骨折的治疗效果及对碱性磷酸酶(ALP)和抗酒石酸酸性磷酸酶-5b(TRACP-5b)水平的影响。方法 2014年6月—2017年6月恩施土家族、苗族自治州中心医院收治90例胸腰段脊柱爆裂性骨折患者,根据随机数字表法分为对照组(45例)和研究组(45例),两组均采用椎弓根固定手术,研究组同时在术后1周给予伊班膦酸钠静脉滴注,2mg/次,1次/d,连续应用2d,每3个月进行1次。比较两组的治疗效果及手术前后血清ALP、TRACP-5b水平变化情况。结果术后1、6、12个月时研究组疼痛视觉模拟评分(VAS评分)分别为(5.06±0.82)、(3.67±0.40)、(1.77±0.21)分,均显著低于对照组(6.94±1.07)、(4.53±0.61)、(2.41±0.19)分(P<0.05);术后3、6、12个月时研究组日本骨科协会胸腰椎治疗评估表(JOA)评分(16.45±2.12)、(10.57±1.74)、(4.47±1.04)分,均显著低于对照组(18.40±2.37)、(13.68±1.81)、(6.69±1.20)分,P<0.05;研究组术后6、12个月时脊柱后凸畸形Cobb角(4.06±1.77)°、(5.46±2.13)°显著小于对照组(5.29±1.71)°、(7.51±3.09)°,伤椎前缘和中部高度显著高于对照组(P<0.05);两组并发症发生率比较差异无统计学意义(P<0.05);术后血清ALP及TRACP-5b水平较术前均明显降低,且术后研究组的血清ALP及TRACP-5b水平均显著低于对照组(P<0.05)。结论椎弓根固定联合伊班膦酸钠对胸腰段脊柱爆裂骨折治疗效果显著,可有效缓解疼痛,矫正脊柱后凸畸形,促进骨生化指标尽早恢复,进而促进骨折的愈合和胸腰椎功能的恢复,而且并发症少,是一种安全有效的治疗方式。

Objective To investigate the efficacy of pedicle fixation combined with ibandronate in treating patients with thoracolumbar burst fractures and their influences on the levels of alkaline phosphatase protein(ALP) and tartra-resistant acid phosphatase-5b (TRACP-5b). MethodsFrom Jun.2014 to Jun.2017,90 patients with thoracolumbar spinal burst fracture in the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture were selected,and divided into two groups: control group ( n =45) and study group ( n =45). Pedicle fixation was performed in both groups. The patients in the study group were given ibandronate intravenously at the same time one week after operation (2mg/time,1 time/d,continuous application for 2 days,once every 3 months). The treatment efficacy and the changes of the serum ALP and TRACP-5b levels before and after operation were compared between the two groups. ResultsThe visual analogue pain scores (VAS) of the study group at 1,6 and 12 months after operation was (5.06±0.82) points,(3.67±0.40) points,(1.77±0.21) points,respectively,which were significantly lower than those of the control group of (6.94±1.07) points,(4.53±0.61) points,(2.41±0.19) points ( P <0.05). Japanese Orthopaedics Association Thoracolumbar Therapeutic Assessment form (JOA) score of the study group at 1,6 and 12 months after operation was (16.45±2.12) points,(10.57±1.74) points,(4.47±1.04) points,respectively,which were significantly lower than those of the control group of (18.40±2.37) points,(13.68±1.81) points,(6.69±1.20) points ( P <0.05). The Cobb s angle of kyphosis of the study group at 6 and 12 months after operation was (4.06±1.77)°,(5.46±2.13)°,respectively,which were significantly lower than those of the control group (5.29±1.71)°,(7.51±3.09)°, P <0.05. The height of anterior and middle part of injured vertebrae was significantly higher than that of control group( P <0.05).There was no significant difference in the incidence of complications between the two groups ( P <0.05). The levels of serum ALP and TRACP-5b after operation were significantly lower than those before operation,and the levels of serum ALP and TRACP-5b in the study group were significantly lower than those in the control group after operation ( P <0.05). ConclusionThe pedicle fixation combined with ibandronate is effective in the treatment of thoracolumbar burst fracture,which can relieve pain,correct kyphosis,promote the recovery of bone biochemical indexes in time,promote the healing of fracture and recovery of the thoracolumbar function with less complications,and can be used as a safe and effective treatment.