经皮椎体成形术联合唑来膦酸对骨质疏松性椎体压缩骨折的疗效分析

Efficacy Analysis of Percutaneous Vertebroplasty Combined with Zoledronic Acid in Osteoporotic Vertebral Compression Fractures

目的分析经皮椎体后凸成形术(PKP)联合唑来膦酸对骨质疏松性椎体压缩骨折(OVCF)患者的疗效影响。方法纳入2018年6月至2021年4月期间确诊OVCF的患者80例,并收集临床资料。随机将研究对象分为试验组与对照组(各40例)。其中,试验组患者予实施PKP+唑来膦酸方案治疗,对照组予实施PKP+阿仑膦酸钠方案治疗。以腰椎功能、骨密度、骨代谢、炎性疼痛介质及骨折再发生率为评估维度,分析PKP联合唑来膦酸对骨质疏松性椎体压缩骨折临床疗效的影响,为OVCF的外科治疗提供新的科学依据。结果与对照组相比,PKP联合唑来膦酸干预组患者:(1)具有更低的Oswestry功能障碍评分(ODI)和更高的骨矿物密度(BMD)(P<0.05);(2)具有更高的骨γ-羟基谷氨酸蛋白(BGP)、骨碱性磷酸酶(BALP)及血清钙离子(Ca^(2+))水平(P<0.05);(3)具有较低水平的血清胰岛素样生长因子-1(IGF-1)、趋化因子(Chemerin)及前列腺素E2(PGE2)(P<0.05)和较高水平的神经肽Y(NPY)和神经生长因子(NGF)(P<0.05);(4)具有更低的术后再骨折发生风险(P<0.05)。结论经皮椎体成形术联合唑来膦酸对OVCF的疗效较传统PKP+阿仑膦酸钠方案在椎体功能与骨密度改善、抑制炎症反应、减轻疼痛、促进骨修复及降低再骨折率等方面具有显著优势,为骨质疏松性椎体压缩骨折的外科应用与基础研究提供了新的视野。

OBJECTIVE Analyzing the effect of percutaneous kyphoplasty(PKP)combined with zoledronic acid on the efficacy of osteoporotic vertebral compression fracture(OVCF)patients.MEHTODS 80 patients diagnosed with OVCF during June 2018 to April 2021 were included and clinical data were collected.The study subjects were randomly divided into the experimental group and the control group(40 cases each).Among them,the patients in the test group were treated with PKP+zoledronic acid regimen,and the patients in the control group were treated with PKP+alendronate regimen.To analyze the effect of PKP combined with zoledronic acid on the clinical efficacy of osteoporotic vertebral compression fractures using lumbar spine function,bone mineral density,bone metabolism,inflammatory pain mediators,and fracture recurrence rate as the assessment dimensions,and to provide a new scientific basis for surgical treatment of OVCF.RESULTS Compared with the control group,patients in the PKP combined with zoledronic acid intervention group:(1)had lower Oswestry Disability Index(ODI)and higher Bone Mineral Density(BMD)(P<0.05);(2)had higher Bone Gla-Protein(BGP),Bone Alkaline Phosphatase(BALP),and serum calcium ion(Ca^(2+))levels(P<0.05);(3)had lower levels of serum Insulin-like Growth Factor-1(IGF-1),Chemerin and Prostaglandin E2(PGE2)(P<0.05)and higher levels of Neuropeptide Y(NPY)and Nerve Growth Factor(NGF)(P<0.05);(4)had a lower risk of postoperative re-fracture(P<0.05).CONCLUSION The efficacy of PKP combined with zoledronic acid in OVCF has significant advantages over the traditional PKP+alendronate regimen in terms of improvement of vertebral function and bone mineral density,inhibition of inflammatory response,reduction of pain,promotion of bone repair,and reduction of the rate of re-fracture,which provides a new horizon for surgical application and basic research on osteoporotic vertebral compression fractures.