经皮穿刺椎体后凸成形术联合不同时机唑来膦酸治疗骨质疏松性椎体压缩骨折的比较研究

Comparative study of percutaneous kyphoplasty combined with zoledronic acid at different times in the treatment of osteoporotic vertebral compression fractures

目的对比经皮穿刺椎体后凸成形术(PKP)联合不同时机唑来膦酸治疗骨质疏松性椎体压缩骨折(OVCF)的效果。方法回顾性分析2018年1月至2019年6月北京市顺义区医院110例OVCF患者的临床资料,其中PKP术后第2天开始唑来膦酸治疗55例(同期组),PKP术后1个月开始唑来膦酸治疗55例(非同期组)。两组患者分别于术前和术后1年行X线检查,测量压缩骨折椎体恢复相关指标,包括椎体前缘高度、椎体后缘高度、椎体后凸角及局部Cobb角;采用Oswestry功能障碍指数(ODI)评估患者的功能障碍程度;检测髋部骨密度;检测血清碱性磷酸酶(ALP)、骨钙素、Ⅰ型胶原交联C-末端肽(CTX-1)。患者随访1年,记录椎体压缩骨折的再发情况。结果两组术前和术后1年椎体前缘高度、椎体后缘高度、椎体后凸角和局部Cobb角比较差异无统计学意义(P>0.05);两组术后1年椎体前缘高度和椎体后缘高度明显高于术前,椎体后凸角和局部Cobb角明显小于术前,差异有统计学意义(P<0.01)。同期组术后1年ODI明显低于非同期组[(11.30±1.53)分比(14.27±1.78)分],差异有统计学意义(P<0.01)。同期组术后1年髋部骨密度明显高于非同期组,差异有统计学意义(P<0.01)。同期组术后1年血清ALP和CTX-1明显低于非同期组[(74.93±8.63)U/L比(78.77±9.41)U/L和(0.24±0.03)ng/L比(0.29±0.03)ng/L],骨钙素明显高于非同期组[(9.63±1.14)ng/L比(7.97±0.85)ng/L],差异均有统计学意义(P<0.01或<0.05)。两组患者均随访1年,未再发生椎体压缩骨折。结论OVCF患者采用PKP术后同期唑来膦酸治疗在改善病情和骨代谢方面更具优势。

Objective To compare the effect of percutaneous kyphoplasty(PKP)combined with zoledronic acid at different times in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods The clinical data of 110 patients with OVCF from January 2018 to June 2019 in the Hospital of Shunyi District Beijing were retrospectively analyzed.All patients were treated with PKP.Among them,55 patients were given zoledronic acid on the second day after surgery(synchronization group),and 55 patients were given zoledronic acid 1 month after surgery(non-synchronization group).X-Ray examination was performed before and 1 year after surgery,and the vertebral recovery related indexes of compression fracture vertebral body were measured,including anterior border height of vertebral body,posterior border height of vertebral body,kyphotic angle and local Cobb angle;the degree of dysfunction was evaluated by Oswestry dysfunction index(ODI);the bone density of hip bone was detected;the serum alkaline phosphatase(ALP),osteocalcin and typeⅠcollagen cross-linked C-terminal peptide(CTX-1)were detected.The patients were followed up for 1 year,and the recurrence of vertebral compression fractures was record.Results There were no statistical differences in anterior border height of vertebral body,posterior border height of vertebral body,kyphotic angle and local Cobb angle before surgery and 1 year after surgery between 2 groups(P>0.05).Compared with those before surgery,the anterior border height of vertebral body and posterior border height of vertebral body 1 year after surgery in 2 groups were significantly higher,the kyphotic angle and local Cobb angle were significantly lower,and there were statistical differences(P<0.01).The ODI 1 year after surgery in synchronization group was significantly lower than that in non-synchronization group:(11.30±1.53)scores vs.(14.27±1.78)scores,and there was statistical difference(P<0.01).The bone density of hip bone 1 year after surgery in synchronization group was significantly higher than that in non-synchronization group,and there was statistical difference(P<0.01).The serum ALP and CTX-11 year after surgery in synchronization group were significantly lower than those in non-synchronization group:(74.93±8.63)U/L vs.(78.77±9.41)U/L and(0.24±0.03)ng/L vs.(0.29±0.03)ng/L,the osteocalcin was significantly higher than that in non-synchronization group:(9.63±1.14)ng/L vs.(7.97±0.85)ng/L,and there were statistical differences(P<0.01 or<0.05).All patients were followed up for 1 year,and no recurrence of vertebral compression fractures was found.Conclusions The synchronization zoledronic acid after PKP has more advantages in improving the condition and bone metabolism in patients with OVCF.