唑来膦酸用于骨质疏松性椎体压缩性骨折患者经皮椎体后凸成形术后疗效观察

Efficacy of Zoledronic Acid in the Treatment of Patients with Osteoporotic Vertebral Compression Fractures After Percutaneous Kyphoplasty

目的探讨唑来膦酸用于骨质疏松性椎体压缩性骨折(OVCF)患者经皮椎体后凸成形术(PKP)后辅助治疗的疗效。方法选取医院2017年7月至2019年7月收治的OVCF行PKP患者118例,按随机信封法分为治疗组和对照组,各59例。对照组患者术后予碳酸钙D3片和骨化三醇软胶囊治疗,治疗组患者术后第3天加用唑来膦酸静脉滴注,均随访1年。结果术后1,6,12个月,治疗组患者的血清骨碱性磷酸酶(BALP)、Ⅰ型胶原C端肽(CTX-1)水平均显著低于术前及对照组同时间点(P <0.05),椎体骨密度显著高于对照组(P <0.05);两组患者的伤椎椎体高度比均较术前显著升高,Cobb角均较术前显著下降(P <0.05),且治疗组显著优于对照组(P <0.05);两组患者的视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)均较术前显著降低(P <0.05),且治疗组术后6个月和12个月均显著低于对照组(P <0.05)。术后1年内,治疗组和对照组骨水泥渗漏发生率相当(11.86%比16.95%,P> 0.05);治疗组再次骨折发生率为3.39%,显著低于对照组的15.25%(P <0.05)。结论唑来膦酸用于OVCF行PKP后辅助治疗疗效较好,可有效调节患者的骨代谢,增加骨密度,利于伤椎恢复,改善疼痛,减轻功能障碍,降低再次骨折发生率。

Objective To investigate the efficacy of zoledronic acid in the adjuvant treatment of patients with osteoporotic vertebral compression fractures( OVCF) after percutaneous kyphoplasty( PKP). Methods A total of 118 patients with OVCF underwent PKP admitted to our hospital from July 2017 to July 2019 were selected and divided into the treatment group and the control group by the random envelope method,59 cases in each group. The patients in the control group were treated with Calcium Carbonate D3 Tablets and Calcitriol Soft Capsules after the operation,and the patients in the treatment group were treated with zoledronic acid by intravenous drip on the third day after the operation. Both groups were followed up for one year. Results One month,six months and twelve months after the operation,the levels of serum bone alkaline phosphatase( BALP) and type Ⅰ collagen C-terminal peptide( CTX-1) in treatment group were significantly lower than those before the operation and those in control group at the same time point( P < 0. 05),and the bone mineral density of vertebral body in the treatment group was significantly higher than that in the control group( P < 0. 05). The vertebral body height ratio of injured vertebrae in the two groups was significantly higher than that before the operation,while the Cobb angle was significantly lower than that before the operation( P < 0. 05),and those in treatment group were significantly better than those in the control group( P < 0. 05). The Visual Analogue Scale( VAS) score and Oswestry Dysfunction Index( ODI) in the two groups were significantly lower than those before the operation( P < 0. 05),while those in the treatment group were significantly lower than those in the control group at six and twelve months after the operation( P < 0. 05). Within one year after the operation,the incidence of bone cement leakage in the treatment group was similar to that in the control group( 11. 86% vs. 16. 95%,P > 0. 05),and the incidence of re-fracture in the treatment group was 3. 39%,which was significantly lower than 15. 25% in the control group( P < 0. 05).Conclusion Zoledronic acid is effective in the adjuvant treatment of patients with OVCF after PKP,which can effectively regulate the bone metabolism,increase the bone mineral density,facilitate the recovery of injured vertebrae,improve pain,relieve dysfunction,and reduce the incidence of re-fracture.