经皮椎体后凸成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折的效果观察

Observation of therapeutic effect of percutaneous kyphoplasty combined with zoledronic acid on osteoporotic vertebral compression fractures

目的分析经皮椎体后凸成形术(PKP)联合唑来膦酸治疗骨质疏松性椎体压缩骨折(OVCF)的临床效果。方法抽取2020年3月至2022年3月开封市中心医院收治的OVCF患者96例,按随机数字表法分为单一组和联合组,每组48例。单一组予以PKP手术治疗,联合组在单一组基础上联合唑来膦酸治疗。比较两组疼痛程度[疼痛数字评分量表(NRS)评分]、功能障碍情况[Oswestry功能障碍指数(ODI)]、伤椎矫正情况(后凸Cobb角、伤椎高度)、骨密度、骨代谢指标[血清骨钙素(SOC)、Ⅰ型前胶原氨基端前肽(PINP)水平]、骨折再发生率及不良反应发生率。结果术后1年,联合组NRS、ODI评分均低于单一组(P均<0.05);联合组后凸Cobb角小于单一组,伤椎高度高于单一组(P<0.05);联合组骨密度大于单一组(P<0.05);联合组SOC水平高于单一组,PINP水平低于单一组(P<0.05);联合组骨折再发生率(0.00%,0/48)低于单一组(12.50%,6/48),P<0.05;联合组不良反应发生率(6.25%,4/48)与单一组(16.67%,8/48)比较,差异未见统计学意义(P>0.05)。结论PKP联合唑来膦酸治疗OVCF,能够减轻患者疼痛程度,提高伤椎矫正效果,改善骨代谢和骨密度情况,减轻功能障碍,降低骨折再发生率,且安全性良好。

Objective To analyze the effects of percutaneous kyphoplasty(PKP)combined with zoledronic acid in the treatment of osteoporotic vertebral compression fractures(OVCF).Methods A total of 96 patients with OVCF treated in Kaifeng Central Hospital from March 2020 to March 2022 were selected,and they were divided into single group and combined group according to random number table method,with 48 cases in each group.The single group was treated by PKP,and the combined group was treated with zoledronic acid based the treatment of the single group.The pain level assessed by numerical rating scale(NRS)score,functional impairment assessed by Oswestry disability index(ODI),vertebral correction(kyphotic Cobb angle,height of injured vertebra),bone density,bone metabolism indicators,including serum osteocalcin(SOC)and type I procollagen N-terminal peptide(PINP),fracture recurrence rate,and incidence of adverse reactions were compared between the two groups.Results One year after operation,the scores of NRS and ODI in the combined group were lower than those in the single group(all P<0.05).The kyphotic Cobb angle in the combined group was smaller than that in the single group,while the injured vertebral height in the combined group was lower than that in the single group(P<0.05);the bone mineral density of the combined group was higher than that of the single group(P<0.05);the SOC level in the combined group was higher than that in the single group,while the PINP level was lower than that in single group(P<0.05).The recurrence rate of fracture in the combined group(0.00%,0/48)was lower than that in the single group(12.50%,6/48),P<0.05.There was no significant difference in the incidence of adverse reactions between the combined group(6.25%,4/48)and the single group(16.67%,8/48),P>0.05.Conclusions PKP combined with zoledronic acid in the treatment of OVCF can alleviate pain,improve the correction effect of injured vertebra,improve bone metabolism and bone mineral density,alleviate dysfunction,and reduce the recurrence rate of fracture,with good safety.