经皮球囊扩张椎体成形术辅助维生素D治疗老年骨质疏松性胸腰椎压缩骨折的远期疗效分析

Long-term efficacy and BMP-7/25-(OH)-D-3 levels of percutaneous kyphoplasty in the treatment of elderly osteoporotic thoracolumbar compression fractures

目的分析经皮球囊扩张椎体成形术(percutaneous kyphoplasty,PKP)辅助维生素D治疗老年胸腰椎单椎体骨质疏松性椎体压缩性骨折(osteoporotic vertebral compression fracture,OVCF)的远期疗效及对转染骨形态发生蛋白-7(BMP-7)/25羟基维生素D3[(25-(OH)-D3]水平的影响。方法选取2017年6月至2021年6月于宁波市医疗中心李惠利医院行PKP治疗的老年胸腰椎单椎体新鲜OVCF患者106例作为研究对象,根据随机数字表法均分为两组各53例。两组均行PKP术治疗并接受常规抗骨质疏松治疗及康复训练,在此基础上,观察组患者辅助维生素D治疗。分别于治疗前及治疗后1、3、6、12个月,检测两组患者疼痛改善程度、Cobb角改善程度、骨密度、椎体压缩率、椎体功能恢复情况及血清BMP-7、25-(OH)-D3水平,同时记录随访1年内所有受试者的骨水泥渗漏率。结果观察组失访2例,对照组失访3例。对比治疗前及治疗后12个月,观察组的骨密度值提高(0.576±0.039 vs 0.868±0.079)g/cm^(2),BMP-7升高(78.36±6.20 vs 153.41±12.70)pg/ml,25-(OH)-D3升高(9.01±2.12 vs 16.24±2.81)ng/ml;而对照组骨密度值提高(0.585±0.042 vs 0.755±0.064)g/cm^(2),BMP-7升高(80.02±6.24 vs 129.87±10.52)pg/ml,25-(OH)-D3升高(9.15±2.16 vs 13.52±2.64)ng/ml;两组升高程度不相等,以观察组的提高最大(P<0.05)。同时观察组的Cobb角降低(13.70±1.89 vs 7.42±0.97)°,椎体压缩率降低(28.97±3.62 vs 18.86±2.02)%、ODI评分降低(75.78±7.43 vs 21.39±2.08)分、VAS评分降低(7.70±0.891 vs 2.32±0.20)分;对照组Cobb角降低(13.54±1.81 vs 8.05±1.05)°,椎体压缩率降低(28.41±3.47 vs 19.86±2.29)%、ODI评分降低(74.42±7.37 vs 24.08±2.41)分、VAS评分降低(7.54±0.81 vs 2.65±0.25)分,而降低程度不等,但以观察组降低最大(P<0.05)。另外,对照组发生椎体再骨折率为22.00%(11/50),而观察组发生椎体再骨折率为5.88%(3/51),组间比较差异有统计学意义(χ^(2)=5.13,P=0.02)。结论PKP辅助维生素D治疗老年胸腰椎OVCF能显著改善BMP-7和25-(OH)-D3水平,更好地恢复骨密度、椎体功能及进行椎体后凸畸形的矫正,远期疗效较为理想。

Objective To analyze the long-term efficacy of percutaneous kyphoplasty(PKP)assisted with vitamin D in the treatment of elderly thoracolumbar single vertebral osteoporotic vertebral compression fractures(OVCF)and its effect on transfected bone morphogenetic protein-Effects of 7(BMP-7)/25-hydroxyvitamin D3[(25-(OH)-D3]levels.Methods 106 elderly patients with fresh OVCF of thoracic and lumbar vertebrae who were treated with PKP in Li Huili Hospital of Ningbo Medical Center from Jun.2017 to Jun.2021 were selected as the research object,and they were divided into two groups according to the random number table method(53 cases in each group).Both groups were treated with PKP and received conventional anti-osteoporosis treatment and rehabilitation training.On this basis,patients in the treatment group were given vitamin D therapy.Before treatment and 1,3,6,and 12 months after treatment,the degree of pain improvement,Cobb angle improvement,bone mineral density,vertebral body compression rate,vertebral body function recovery and serum BMP-7,25-(OH)-D3 level,and the cement leakage rate of all subjects within 1 year of follow-up was recorded.Results Two patients in the observation group and 3 patients in the control group lost to follow-up.Comparing the results of before treatment and 12 months after treatment:the control group’s BMD increased from 0.585±0.042 to 0.755±0.0641;BMP-7 increased from 80.02±6.24 to 129.87±10.52;25-(OH)-D3 increased from 9.15±2.16 to 13.52±2.64;and the treatment group’s BMD increased from 0.576±0.039 to 0.868±0.079;BMP-7 increased from 78.36±6.20 to 153.41±12.70;25-(OH)-D3 increased from 9.01±2.12 to 16.24±2.81;the treatment group had higher increase(P<0.05).Meanwhile the control group’s Cobb angle decreased from 13.54±1.81 to 8.05±1.05;vertebral body compression rate decreased from 28.41±3.47 to 19.86±2.29;ODI score decreased from 74.42±7.37 to 24.08±2.41;VAS score decreased from7.54±0.81 to 2.65±0.25,and the treatment group’s Cobb angle decreased from 13.70±1.89 to 7.42±0.97;vertebral body compression rate decreased from 28.97±3.62 to 18.86±2.02;ODI score decreased from75.78±7.43 to 21.39±2.08;VAS score decreased from7.70±0.891 to 2.32±0.20,while the treatment group decreased more(P<0.05).In addition,the vertebral refracture rate in the control group was 22.00%(11/50),while the vertebral refracture rate in the treatment group was 5.88%(3/51),and there was a significant difference between the groups(χ^(2)=5.125,P=0.024).Conclusion PKP combined with vitamin D in the treatment of elderly thoracolumbar OVCF can significantly improve the levels of BMP-7 and 25-(OH)-D3,better restore bone mineral density,vertebral body function and correct kyphosis,with a more ideal long-term efficacy.