双膦酸盐类药物联合骨化三醇预防老年骨质疏松性胸腰段椎体压缩骨折PVP后再骨折的效果观察

Effect of bisphosphonates combined with calcitriol on prevention of refracture after PVP of osteo porotic thoracolumbar vertebral compression fractures in the elderly

目的观察双膦酸盐类药物联合骨化三醇预防老年骨质疏松性胸腰段椎体压缩骨折经皮椎体成形术(Percutaneous vertebroplasty,PVP)后再骨折的临床效果。方法将2019年4月至2021年5月在我院已行PVP术的84例老年骨质疏松性胸腰段椎体压缩骨折患者随机分为对照组和观察组,每组42例。对照组予以骨化三醇治疗,在此基础上,观察组加用唑来膦酸治疗,均连续治疗1年。观测并比较两组患者治疗前、治疗后6、12个月骨密度(BMD)及骨转换生化指标,同时对比两组术后再骨折发生率。结果术后6、12个月,两组腰椎的BMD值均不断升高,且观察组高于对照组,差异有统计学意义(P<0.05);两组sVCAM-1、sICAM-1以及sBAP、uNTX水平均呈明显下降趋势,且观察组低于对照组,差异有统计学意义(P<0.05);观察组术后再骨折发生率(2.50%)低于对照组(17.95%),差异有统计学意义(χ^(2)=5.18,P=0.02)。结论PVP术后采用唑来膦酸联合骨化三醇进行治疗,可明显提高老年骨质疏松性胸腰段椎体压缩骨折患者骨密度,降低骨转换率,一定程度上可有效预防再次骨折的发生,同时亦能够抑制患者骨折断端的炎症反应,促进骨折愈合。

Objective To observe the clinical effect of bisphosphonates combined with calcitriol in preventing refracture after percutaneous vertebroplasty(PVP)of senile osteoporotic thoracolumbar vertebral compression fractures.Methods 84 elderly patients with osteoporotic thoracolumbar vertebral compression fractures who had undergone PVP in our hospital from April 2019 to May 2021 were randomly divided into control group and observation group,with 42 cases in each group.The control group was treated with calcitriol.On this basis,the observation group was treated with zoledronic acid for 1 year.Bone mineral density(BMD)and bone turnover biochemical indexes were observed and compared between the two groups before treatment,6 and 12 months after treatment,and the incidence of refracture after operation was compared between the two groups.Results At 6 and 12 months after operation,the BMD value of lumbar vertebrae in the two groups increased continuously,and the BMD value in the observation group was significantly higher than that in the control group,with a statistically significant difference(P<0.05);The levels of sVCAM-1,sICAM-1,sBAP and uNTX in the two groups were significantly lower than those in the control group,with a statistically significant difference(P<0.05);The incidence of postoperative re fracture in the.observation group(2.50%)was significantly lower than that in the control group(17.95%),with a statistically significant difference(χ^(2)=5.18,P=0.02).Conclusion After PVP operation,zoledronic acid combined with calcitriol can significantly improve the bone density of elderly patients with osteoporotic thoracolumbar vertebral compression fractures,reduce the bone turnover rate,effectively prevent the occurrence of secondary fractures to some extent,and also can inhibit the inflammatory reaction at the bone fracture end of patients and promote fracture healing.