帕米膦酸二钠治疗骨纤维结构不良的观察

An observation on pamidronate used for treatment of osteofibrous dysplasia

[目的]探讨帕米膦酸二钠治疗骨纤维结构不良的临床疗效。[方法]回顾性分析2011年1月—2021年1月本科采用静脉滴注帕米膦酸二钠治疗的38例骨纤维结构不良患者的临床资料。[结果]1例患者首次用药时出现发热。5例患者用药期间出现病理性骨折,其中4例行刮除植骨内固定术,1例行单纯髓内针内固定术。随访12~48个月,平均(30.79±13.03)个月。随时间推移,VAS评分显著降低(P<0.05),而SF-36评分显著升高(P<0.05);血清I型胶原C端肽和血清I型胶原N端肽显著降低(P<0.05),但是血清骨钙素无显著变化(P>0.05)。影像方面,与治疗前相比,用药6个月后3例患者病变区域缩小,32例患者病变区域无变化,3例患者的病变区域扩大;末次随访时,7例患者病变区域缩小,27例患者病变区域无变化,4例患者的病变区域扩大。[结论]帕米膦酸二钠治疗骨纤维结构不良能够减轻患者疼痛,降低骨代谢指标,延缓疾病的进展,并且不良反应轻微。

[Objective] To investigate the clinical efficacy of pamidronate used for the treatment of osteofibrous dysplasia(OFD).[Methods] A retrospective study was performed on 38 patients who received pamidronate intravenously for OFD in our department from January 2011 to January 2021. [Results] Fever occurred in 1 patient at the time of first medication. Pathological fractures occurred in 5 patients during the treatment period, which in 4 patients underwent curettage, bone graft and internal fixation, while the other one received intramedullary nailing for internal fixation only. With time of follow-up lasted for 12~48 months with a mean of(30.79±13.03) months, the VAS scores decreased significantly(P<0.05), while the SF-36 score increased significantly(P<0.05);in addition, serum C-terminal type Ⅰ procollagen(C1NP) and serum N-terminal propeptide of type Ⅰprocollagen(PINP) significantly decreased(P<0.05), whereas the serum osteocalcin remained unchanged(P<0.05). Compared with that before treatment, the lesion area on radiographs reduced in 3 patients, remained unchanged in 32 patients, and enlarged in 3 patients at 6 months after treatment, whereas reduced in 7 patients, unchanged in 27 patients,and enlarged in 4 patients at the latest follow-up. [Conclusion] The pamidronate used for the treatment of OFD does relieve pain, decline bone metabolic markers and delay the progression of the disease with mild adverse reactions.