摘要
目的 观察唑来膦酸联合骨化三醇治疗对老年骨质疏松性胸腰椎压缩骨折(osteoporotic thoracolumbar compression fracture,OTCF)患者经皮椎体成形术(percutaneous vertebroplasty,PVP)后再骨折的临床效果。方法 选择2019年4月至2021年5月在安徽医科大学附属滁州医院行PVP治疗的84例老年OTCF患者,采用随机数字表法分为观察组和对照组,每组42例。对照组术后给予骨化三醇治疗,观察组在对照组的基础上加用唑来膦酸治疗,均连续治疗1年。比较两组患者治疗前及治疗后6个月、12个月时的骨密度、炎症反应指标、骨转换生化指标及再骨折发生率。结果 治疗前两组腰椎及左侧股骨颈的骨密度比较差异无显著性(P>0.05);治疗后6个月及12个月时,两组腰椎及左侧股骨颈的骨密度明显高于治疗前,且观察组明显高于对照组,差异均有显著性(P<0.05)。治疗前两组炎症反应指标血清可溶性血管细胞黏附分子-1(serum vascular cell adhesion molecule-1,sVCAM-1)、血清可溶性细胞间黏附分子-1(serum intercellular cell adhesion molecule-1,sICAM-1)及骨转换生化指标尿Ⅰ型胶原氨基末端肽(urine N-telopeptides of typeⅠcollagen,uNTX)、血清骨特异性碱性磷酸酶(serum bone spesific alkaline phosphatase,sBAP)水平比较差异无显著性(P>0.05);治疗后6个月和12个月时,两组sVCAM-1、sICAM-1、uNTX、sBAP水平均明显低于治疗前,且观察组明显低于对照组,差异有显著性(P<0.05)。观察组术后1年内再骨折发生率(2.50%)明显低于对照组(17.95%),差异有显著性(χ^(2)=5.18,P=0.02)。结论 老年OTCF患者PVP术后采用唑来膦酸联合骨化三醇治疗对提升骨密度、降低骨转换率有积极作用,并能在一定程度上预防再骨折的发生,值得临床应用。
Objective To observe the clinical effect of bisphosphonates combined with calcitriol in preventing refracture after percutaneous vertebroplasty(PVP)for osteoporotic thoracolumbar vertebral compression fracture in the elderly.Method 84 elderly patients with osteoporotic thoracolumbar vertebral compression fracture who underwent 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 after operation,and the observation group was treated with zoledronic acid on the basis of the control group for one year.The bone mineral density(BMD),biochemical indicators of bone turnover and the incidence of postoperative re-fracture were compared between the two groups before treatment and 6 and 12 months after treatment.Result Before treatment,there was no significant difference between the BMD values of lumbar spine and left femoral neck between the two groups(P>0.05);At 6 and 12 months after treatment,the BMD values of lumbar spine and left femoral neck in both groups increased continuously,and the observation group was significantly higher than the control group(P<0.05);Before treatment,there was no significant difference in the levels of serum vascular cell adhesion molecule-1(sVCAM-1),serum intercellular cell adhesion molecule-1(sICAM-1),serum bone specific alkaline phosphatase(sBAP)and urine N-telopeptides of typeⅠcollagen(uNTX)between the two groups(P>0.05);After 6 and 12 months of treatment,the levels of the above indicators in the two groups showed a significant downward trend,and the observation group was significantly lower than the control group(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%),and the difference was statistically significant(χ^(2)=5.18,P=0.02).Conclusion Zoledronic acid combined with calcitriol can effectively improve the bone mineral density and reduce the bone turnover rate
作者
王天成
章维新
王道成
孔杨
蔡东高
Wang Tiancheng;Zhang Weixin;Wang Daocheng;Kong Yang;Cai Donggao(Department of Orthopedics,Affiliated Chuzhou Hospital of Anhui Medical University/First People’s Hospital of Chuzhou,Anhui Chuzhou 239001,China)
出处
《中国医刊》
CAS
2023年第7期730-734,共5页
Chinese Journal of Medicine
基金
安徽医科大学校科研基金项目(自然科学)(2022xkj223)。
关键词
骨质疏松性胸腰椎压缩骨折
经皮椎体成形术
唑来膦酸
骨化三醇
再骨折
Osteoporosis thoracolumbar vertebral compression fracture
Percutaneous vertebroplasty
Bisphosphonates
Calcitriol
Refracture
