骨质疏松性椎体压缩骨折经皮椎体成形术后再发骨折预防措施研究进展

Progress on preventive measures of recurrent fractures after percutaneous vertebroplasty for osteoporotic vertebral compression fracture

骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)经皮椎体成形术(percutaneous vertebroplasty,PVP)后如何降低椎体再发骨折率是脊柱外科领域的难题,对此深入研究预防措施在诊治中具有重要意义。近年来研究发现新型抗骨质疏松药物,如特立帕肽、地舒单抗、阿巴帕肽和罗莫单抗等,对于预防再发骨折具有显著效果。此外,部分抗骨质疏松药物的序贯治疗方案,如促成骨细胞序贯抑破骨细胞药物治疗、抑破骨细胞序贯促成骨细胞药物治疗、双重作用机制序贯抑破骨细胞药物治疗、抑破骨细胞序贯抑破骨细胞药物治疗和一些联合治疗方案可有效提升骨密度,同时降低再发骨折风险。通过对PVP术式进行改良,如经皮弯角椎体成形术、骨填充网袋椎体成形术、经皮可弯曲椎体后凸成形术,侧开口套管椎体成形术、明胶海绵预填充椎体成形术等,发现可以降低OVCF患者椎体再发骨折率。并且研究发现,术后高效的管理模式(骨折联络服务、个案管理模式、协同服务模式、三维护理模式和延续性护理模式等),可降低椎体再发骨折率。通过对抗骨质疏松药物治疗方案、PVP术式的改良、管理模式的应用等方面进行研究发现,这些预防措施从不同维度降低了OVCF患者经PVP术后椎体再发骨折率,为预防术后椎体再发骨折提供了科学依据。

How to reduce the rate of recurrent vertebral fractures after percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF)is a challenge in the field of spinal surgery.in-depth research on preventive measures is of great significance in its diagnosis and treatment.In recent years,research has found that new anti-osteoporosis drugs,such as terlipide,desucumab,abalatide,and romosozumab,have significant effects on preventing recurrent fractures.In addition,some sequential treatment regimens of anti-osteoporosis drugs,such as stimulator of bone formation drugs sequential anti-resorptive drugs,anti-resorptive drugs sequential stimulator of bone formation drugs,anti-resorptive drugs sequential anti-resorptive drugs,dual mechanism drugs sequential anti-resorptive drugs,and some combined treatment schemes can effectively improve bone mineral density and reduce the risk of recurrent fractures.Through research on the modified procedure for PVP,such as percutaneous curved vertebroplasty,bone-filled mesh vertebroplasty,percutaneous curved kyphoplasty,side-opening cannula PVP,and gelatin sponge pre-filling combined with PVP,it was found that the rate of recurrent vertebral fractures in OVCF patients could be reduced.In addition,the study found that efficient management modes after operation(such as fracture liaison service,case management model,collaborative nursing model,three-dimensional nursing model,and continuous nursing model),can reduce the rate of recurrent vertebral fractures.Through the study of anti-osteoporosis drug treatment regimens,modified procedure for PVP and application of management mode,it was found that these preventive measures reduce the rate of recurrent vertebral fractures after PVP in OVCF patients from different dimensions,providing a scientific basis for the prevention of recurrent vertebral fractures after PVP.