弯角穿刺椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩性骨折的临床研究

Clinical study of the treatment of vertebral compression fracture caused by osteoporotic vertebroplasty combined with zoledronic acid

目的:研究弯角穿刺椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩性骨折的临床疗效。方法:将2017年1月至2020年1月间120例(120个椎体)骨质疏松性脊柱压缩性骨折患者随机分为3组。观察组40例,行弯角穿刺椎体成形术,在术后3d给予静脉滴注唑来膦酸;对照A组40例,单纯行弯角穿刺椎体成形术;对照B组40例,行单侧穿刺椎体成形术,在术后3d给予静脉滴注唑来膦酸。分别在术前及术后1周、6mon、1a采用视觉模拟评分(VAS)评估疼痛缓解程度,用Oswestry功能障碍指数评分(oswestrydisabilityindex,ODI)评估手术前后脊柱疼痛对日常活动的影响。用术后1a椎体再发骨折情况及测量骨密度来评估各组治疗效果。结果:三组患者术后1周疼痛均有明显的缓解,但是相对于对照组,观察组在术后6mon及1a的VAS评分显著减少,生活质量提高更明显,差异有统计学意义(P<0.05)。三组患者术后1周ODI指数均显著降低,但是相对于对照组。观察组在术后6mon及1a的ODI指数显著减少,差异有统计学意义(P<0.05)。术后1a观察组与对照A组比较,骨密度明显增加,差异有统计学意义(P<0.05);与对照B组比较,骨密度都有明显增加,差异无统计学意义(P>0.05)。观察组术后1a有2例椎体再发骨折,对照A组有10例椎体再发骨折,对照B组有8例椎体再发骨折,差异有统计学意义(P<0.05)。结论:弯角穿刺椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩性骨折不仅能快速缓解患者的疼痛,提高生活质量,而且降低术后椎体再骨折发生率,增加了骨密度,并且依从性良好,使用方便,值得临床推广。

Objective:To study the clinical effect of bended Angle puncture vertebroplasty combined with zoledronic acid in the treatment of osteoporotic vertebral compression fracture.Methods:One hundred twenty patients(120 vertebral bodies)with osteoporotic spinal compression fractures from January 2017 to January 2020 were randomly divided into three groups,observation group(40 cases),vertebroplasty was performed and zoledronic acid was given intravenously 3 days after surgery;control group A:40 cases,percutaneous vertebroplasty with a simple corner puncture was performed.control group B:40 cases,underwent unilateral puncture vertebroplasty and intravenous infusion of zoledronic acid in 3 days after surgery.Visual analogue scale(VAS)was used to evaluate pain relief before surgery,1 week,6 months,and 1 year after surgery,respectively,the effect of spinal pain on daily activities before and after surgery was assessed using the Oswestry Disability Index(ODI),one year after the operation,the incidence of vertebral fractures and bone mineral density were measured to evaluate the treatment effect of the three groups.Results:The pain in three groups was significantly relieved one week after the operation,.however,compared with the control group,the VAS scores in the observation group were significantly reduced at 6 months and 1 year after surgery.the quality of life improved significantly,and the difference was statistically significant(P<0.05).The ODI index in both groups decreased significantly one week after surgery.however,compared with the control group,the ODI index in the observation group was significantly reduced at 6 months and 1 year after surgery.the difference was statistically significant(P<0.05).One year after the operation,the bone mineral density of the observation group and the control group A increased significantly,and the difference was statistically significant(P<0.05),the bone mineral density was significantly increased compared with control group B(P>0.05).One year after surgery,2 cases of vertebral refracture occurred in the observation group,10 cases in the control group A,and 8 cases in the control group B.(P<0.05).Conclusion:Vertebroplasty combined with zoledronic acid in the treatment of osteoporotic vertebral compression fractures can not only quickly relieve the pain of patients,to improve the quality of life,But also reduced postoperative vertebral refractures,increased bone density,and good compliance,It is convenient to use and worthy of clinical promotion.