唑来膦酸联合单侧穿刺PKP术治疗老年骨质疏松性椎体压缩性骨折的疗效及不良反应的预防

发布时间：2018-10-04 18:43

【摘要】：目的观察经皮球囊扩张椎体成形术(PKP)联合静滴唑来膦酸治疗老年骨质疏松性椎体压缩性骨折(OVCF)的疗效及超前预防性使用非甾体消炎镇痛药西乐葆对静滴唑来膦酸后急性期不良反应(APR)的预防治疗效果。方法回顾性分析武汉市普爱医院于2010年1月至2013年12月采用单侧PKP术治疗单节段老年骨质疏松性椎体压缩性骨折并获得1年以上随访的患者116例,根据患者术后是否应用唑来膦酸(密固达)分为A(试验组,67例)、B(对照组,49例)两组,其中A组PKP术后3d使用唑来膦酸,根据是否在静滴唑来膦酸前3d给予西乐葆口服,又将A组分为C(非西乐葆组,30例)、D(西乐葆组,37例)两组。分别测量A组和B组患者术前及术后1年的骨密度,对PKP术后邻近椎体骨折(AVF)的发生率进行统计,术前、术后随访时采用疼痛视觉模拟评分(VAS)评估疼痛程度,采用Oswestry评分评估活动能力,并对骨折椎体高度及Cobb角变化进行分析,评估PKP联合唑来膦酸治疗老年骨质疏松性椎体压缩性骨折的疗效。同时观察C组和D组APR的发生率,发热程度及肌肉骨骼疼痛程度的差异,评估超前预防性使用西乐葆对静滴唑来膦酸后APR的预防效果。结果治疗1年后A组患者股骨近端骨密度明显提高,治疗后1年内无新发椎体骨折的发生,B组术后1年期间有脊柱骨性疼痛加重趋势,随访期间新发椎体骨折10例,其中新发AVF 6例。两组患者术后伤椎椎体高度、Cobb角、VAS评分和Oswestry评分均较术前明显改善,差异有统计学意义(均P0.05),但术后两组间比较无显著性差异。C组和D组APR发生率、发热及肌肉骨骼疼痛程度差异均有统计学意义(均P0.01)。两组患者均无其它不良反应发生。结论唑来膦酸联合PKP技术治疗老年骨质疏松性骨折效果显著,可明显提高骨质疏松性患者骨密度,预防骨量持续丢失,提高患者生活质量,并有效减轻全身及脊柱骨性疼痛症状,预防再次骨折的发生,可作为骨质疏松性骨折PKP术后一种有效的辅助治疗措施。超前预防性使用非甾体消炎镇痛药西乐葆可大大降低静滴唑来膦酸后急性期不良反应的发生率及发热和肌肉骨骼疼痛的程度。
[Abstract]:Objective to observe the efficacy of percutaneous balloon dilatation vertebroplasty (PKP) combined with intravenous dazoledronic acid in the treatment of senile osteoporotic vertebral compression fracture (OVCF) and the prophylactic use of nonsteroidal antiinflammatory analgesics (NSAID) Celebrex in the treatment of intravenous zoledronic acid. Prevention and treatment effect of (APR) in post acute adverse reaction. Methods from January 2010 to December 2013, 116 patients with unilateral osteoporotic vertebral compression fractures were treated with unilateral PKP and followed up for more than one year. According to whether the patients were treated with zoledronic acid or not, they were divided into two groups: group A (67 cases of experimental group) and group B (49 cases of control group). Group A received zoledronic acid 3 days after operation, according to whether Celebrex was given orally 3 days before intravenous didzoledronic acid. Group A was divided into two groups: C (30 cases of non-Celebrex group) and D group (37 cases of Celebrex group). Bone mineral density (BMD) of patients in group A and group B were measured before and 1 year after operation. The incidence of (AVF) in patients with adjacent vertebral body fractures after PKP was counted. The pain degree was evaluated by visual analogue score (VAS) during follow-up before and after operation. The activity ability was evaluated by Oswestry score and the changes of vertebral height and Cobb angle were analyzed to evaluate the efficacy of PKP combined with zoledronic acid in the treatment of senile osteoporotic vertebral compression fracture. At the same time, the incidence of APR, the degree of fever and the degree of musculoskeletal pain were observed between group C and group D, and the preventive effect of prophylaxis of Celebrex on APR after intravenous tiazoledronic acid was evaluated. Results the bone mineral density of proximal femur increased significantly in group A one year after treatment, and there was no new vertebral body fracture in group B during one year after treatment. There was a tendency of spinal bone pain in group B, and 10 cases of new vertebral body fracture occurred during follow-up. Among them, 6 cases were newly developed AVF. The VAS score and Oswestry score of the injured vertebral body height were significantly improved in the two groups (P0.05), but there was no significant difference between the two groups after operation. The incidence of APR in group C and group D was not significantly different between the two groups. There were significant differences in fever and musculoskeletal pain (P 0.01). No other adverse reactions occurred in both groups. Conclusion Zoledronic acid combined with PKP is effective in the treatment of osteoporotic fracture in elderly patients. It can significantly increase bone density, prevent bone loss and improve quality of life in patients with osteoporosis. It can effectively relieve the symptoms of systemic and spinal bone pain and prevent the occurrence of refracture. It can be used as an effective adjuvant treatment for osteoporotic fracture after PKP. Prophylaxis of nonsteroidal anti-inflammatory and analgesic drug Celebrex can significantly reduce the incidence of adverse reactions and the degree of fever and musculoskeletal pain after intravenous drip of azoledronic acid.
【作者单位】：华中科技大学同济医学院附属武汉市普爱医院脊柱外科;
【基金】：卫生部卫生行业专项项目(No.W2014ZT294)
【分类号】：R580;R687.3

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