骨化三醇对老年骨质疏松性脊柱骨折病人PKP术后骨折愈合的影响

Effects of calcitriol on fracture healing in elderly patients with osteoporotic vertebral fractures undergoing PKP surgery

目的研究骨化三醇用于老年骨质疏松性椎体压缩性骨折(OVCF)病人经皮椎体后凸成形术(PKP)后治疗对骨折愈合和血清骨碱性磷酸酶(BALP)、Ⅰ型前胶原N-端前肽(PINP)、胶原羧基端肽β特殊序列(β-CTX)表达水平的影响。方法纳入2019—2020年我院接受PKP手术的106例OVCF病人为研究对象,并采用随机数表法均分为观察组和对照组,每组53例。对照组PKP术后给予钙剂+阿仑膦酸钠片进行治疗,观察组在此基础上加用骨化三醇进行治疗,2组疗程均为6个月,比较2组临床疗效、Cobb角、Oswestry功能障碍指数(ODI)、骨密度和骨代谢指标的差异。结果2组治疗6个月有效率分别为90.57%和83.02%,差异无统计学意义(P>0.05),优良率分别为73.58%和52.83%,差异有统计学意义(P<0.05)。2组治疗1、3、6个月时Cobb角和ODI均明显低于治疗前(P<0.05),且观察组治疗6个月时ODI低于对照组,差异有统计学意义(P<0.05)。2组治疗3、6个月时骨密度均明显高于治疗前(P<0.05),且观察组治疗6个月时骨密度高于对照组,差异有统计学意义(P<0.05)。与治疗前相比,2组治疗1、3、6个月时BALP和PINP水平明显升高(P<0.05),β-CTX水平均明显降低(P<0.05),且观察组治疗1、3、6个月时BALP和PINP水平均高于对照组,差异有统计学意义(P<0.05)。结论OVCF病人PKP术后应用骨化三醇进行治疗具有良好效果,有利于改善骨代谢并增加骨密度,对促进骨折愈合、改善脊柱功能和提升日常生活能力具有积极作用。

Objective To study the effects of calcitriol on fracture healing and the levels of serum bone alkaline phosphatase(BALP),procollagen typeⅠN-terminal propeptide(PINP)andβ-typeⅠcollagen carboxyl terminal peptide(β-CTX)in the elderly patients with osteoporotic vertebral compression fractures(OVCF)receiving percutaneous kyphoplasty(PKP).Methods A total of 106 patients with OVCF who received PKP surgery in Hanyang Hospital Affiliated to Wuhan University of Science and Technology from January 2019 to December 2020 were enrolled in this study.And they were divided into control group and observation group according to the random number table method,with 53 cases in each group.The control group was treated with calcium combined with alendronate sodium tablets after PKP surgery,while the observation group was additionally given calcitriol.The course of treatment in both groups was 6 months.The clinical efficacy and the levels of Cobb angle,Oswestry disability index(ODI),bone mineral density and bone metabolism indicators were compared between the two groups.Results The effective rates in the observation group and the control group after 6 months of treatment were 90.57%and 83.02%(P>0.05),and the excellent and good rates were 73.58%and 52.83%(P<0.05).The levels of Cobb angle and ODI in the two groups after 1,3 and 6 months of treatment were significantly lower than those before treatment(P<0.05),and the level of ODI in the observation group was significantly lower than that in the control group after 6 months of treatment(P<0.05).The bone mineral density after 3 and 6 months of treatment in both groups were significantly higher than those before treatment(P<0.05),and the bone mineral density after 6 months of treatment in the observation group was higher than that in the control group(P<0.05).The levels of BALP and PINP were significantly increased after 1,3 and 6 months of treatment(P<0.05),while the level ofβ-CTX was significantly decreased(P<0.05)in the two groups,and the levels of BALP and PINP in the observation group were higher than those in the control group after 1,3 and 6 months of treatment(P<0.05).Conclusions Calcitriol shows good effects in the treatment of patients with OVCF after PKP surgery through improving the bone metabolism and enhancing the bone mineral density,and it could promote the fracture healing.