唑来膦酸预防骨质疏松性椎体压缩性骨折术后椎体再发骨折的疗效分析

doi:10.11958/20220262

天津医药 ›› 2023, Vol. 51 ›› Issue (11): 1258-1261.doi: 10.11958/20220262

唑来膦酸预防骨质疏松性椎体压缩性骨折术后椎体再发骨折的疗效分析

钱黎(), 王大寿, 潘奇, 肖杨, 段斌武, 陈黔^△()

贵州省骨科医院（邮编550002）

收稿日期:2022-11-17 修回日期:2023-02-06 出版日期:2023-11-15 发布日期:2023-11-07
通讯作者: ^△E-mail：chen163q@tom.com
作者简介:钱黎（1986），男，副主任医师，主要从事骨质疏松症并椎体压缩性骨折、神经病理性疼痛、早期股骨头坏死等疾病的诊疗方面研究。E-mail：wsql-bio@163.com
基金资助:
贵州省卫健委科学技术基金项目(gzwkj2022-383)

Analysis of clinical effect of vertebroplasty combined with zoledronate in preventing postoperative recurrence of vertebral fractures

QIAN Li(), WANG Dashou, PAN Qi, XIAO Yang, DUAN Binwu, CHEN Qian^△()

Guizhou Orthopedics Hospital, Guiyang 550002, China

Received:2022-11-17 Revised:2023-02-06 Published:2023-11-15 Online:2023-11-07
Contact: ^△E-mail：chen163q@tom.com

钱黎, 王大寿, 潘奇, 肖杨, 段斌武, 陈黔. 唑来膦酸预防骨质疏松性椎体压缩性骨折术后椎体再发骨折的疗效分析[J]. 天津医药, 2023, 51(11): 1258-1261.

QIAN Li, WANG Dashou, PAN Qi, XIAO Yang, DUAN Binwu, CHEN Qian. Analysis of clinical effect of vertebroplasty combined with zoledronate in preventing postoperative recurrence of vertebral fractures[J]. Tianjin Medical Journal, 2023, 51(11): 1258-1261.

摘要/Abstract

摘要：

目的探究唑来膦酸对骨质疏松性椎体压缩性骨折（OVCF）行椎体成形术治疗后再发骨折的影响。方法回顾性收集OVCF患者152例，根据术后唑来膦酸输注情况分为唑来膦酸组（68例）和对照组（84例）。记录2组术前和术后3、6、12个月的疼痛视觉模拟评分（VAS）和骨密度（BMD）T值。酶联免疫吸附试验测定血清Ⅰ型前胶原氨基端肽（P1NP）、β-胶联降解产物（β-CTX）等骨代谢指标。术后随访2年，记录椎体再发骨折发生情况。结果与对照组相比，唑来膦酸组术后3、6和12个月BMD T值升高，疼痛VAS、β-CTX和P1NP下降（P<0.05）。术后2年，唑来膦酸组再发椎体骨折率（5.95%，5/84）低于对照组（16.18%，11/68；χ²=4.171，P<0.05）。结论唑来膦酸可有效预防PVP治疗后OVCF患者再发椎体骨折。

关键词: 骨质疏松, 骨折, 压缩性, 唑来膦酸, 椎体成形术, 复发

Abstract:

Objective To investigate the effect of zoledronic acid on the recurrence of osteoporotic vertebral compression fracture (OVCF) after vertebroplasty. Methods One hundred and fifty-two patients with OVCF were retrospectively collected. According to postoperative zoledronic acid infusion, patients were divided into the zoledronic acid group (68 cases) and the control group (84 cases). The visual analogue scale (VAS) score and bone mineral density (BMD) T value were recorded before operation and at 3, 6 and 12 months after operation. Serum procollagen type I N-terminal peptide (P1NP) and β-collagen degradation products (β-CTX) were measured by enzyme-linked immunosorbent assay. The patients were followed up for 2 years to record the occurrence of vertebral fracture. Results Compared with the control group, BMD T value was significantly increased, VAS score was decreased, β-CTX and P1NP were decreased at 3, 6 and 12 months after operation in the zoledronic acid group (P<0.05). Two years after operation, the recurrence rate of vertebral fracture was lower in the zoledronic acid group (5/84, 5.95%) than that in the control group (11/68, 16.18%) (χ²=4.171, P<0.05). Conclusion Zoledronic acid can effectively prevent the recurrence of vertebral fracture in patients with OVCF after PVP.

Key words: osteoporosis, fractures, compression, zoledronic acid, vertebroplasty, recurrence

中图分类号:

R553.65

图/表 5

参考文献 15

[1]	LEWIECKI E M. Intravenous zoledronic acid for the treatment of osteoporosis:the evidence of its therapeutic effect[J]. Core Evid, 2010, 4:13-23. doi:10.2147/ce.s6011.
[2]	SUN Y, MA H, YANG F, et al. Clinical efficacy and safety of zoledronic acid combined with PVP/PKP in the treatment of osteoporotic vertebral compression fracture:a systematic review and Meta-analysis of randomized controlled trials[J]. Biomed Res Int, 2021, 2021:6650358. doi:10.1155/2021/6650358.
[3]	ZHOU T, LIN H, WANG H, et al. Comparative study on the biomechanics between improved PVP and traditional PKP in the treatment of vertebral peripheral wall damage-type OVCF[J]. Exp Ther Med, 2017, 14(1):575-580. doi:10.3892/etm.2017.4542.
[4]	皮海菊, 肖淼生, 尚晖. 经皮椎体后凸成形术治疗陈旧性骨质疏松椎体压缩性骨折疗效观察[J]. 中国临床研究, 2017, 30(1):27-30.
	PI H J, XIAO M S, SHANG H. Observation of curative effect of percutaneous kyphoplasty for treatment of old osteoporotic vertebral compression fractures[J]. Chinese Journal of Clinical Research, 2017, 30(1):27-30. doi:10.13429/j.cnki.cjcr.2017.01.007.
[5]	YU W, XU W, JIANG X, et al. Risk factors for recollapse of the augmented vertebrae after percutaneous vertebral augmentation:a systematic review and meta-analysis[J]. World Neurosurg, 2018, 111:119-129. doi:10.1016/j.wneu.2017.12.019.
[6]	GOLDSTEIN C L, CHUTKAN N B, CHOMA T J, et al. Management of the elderly with vertebral compression fractures[J]. Neurosurgery, 2015, 77(Suppl 4):S33-45. doi:10.1227/NEU.0000000000000947.
[7]	SIRIS E S, ADLER R, BILEZIKIAN J, et al. The clinical diagnosis of osteoporosis:a position statement from the National Bone Health Alliance Working Group[J]. Osteoporos Int, 2014, 25(5):1439-1443. doi:10.1007/s00198-014-2655-z.
[8]	蓝涛, 陈扬, 杨欣建. 椎体成形术后再骨折研究进展[J]. 中国脊柱脊髓杂志, 2015, 25(2):179-182.
	LAN T, CHEN Y, YANG X J. Progress on refracture after vertebroplasty[J]. Chinese Journal of Spinal Cord, 2015, 25(2):179-182. doi:10.3969/j.issn.1004-406X.2015.02.14.
[9]	ZHANG H, XU C, ZHANG T, et al. Does percutaneous vertebroplasty or balloon kyphoplasty for osteoporotic vertebral compression fractures increase the incidence of new vertebral fractures? A Meta-Analysis[J]. Pain Physician, 2017, 20(1):E13-E28.
[10]	刘鹤飞, 吴春根, 田庆华, 等. 椎体压缩性骨折PVP术后再发骨折危险因素的研究进展[J]. 介入放射学杂志, 2017, 26(9):855-858.
	LIU H F, WU C G, TIAN Q H, et al. The risk factors of recurrent fracture in patients having received percutaneous vertebroplasty for vertebral compression fracture:recent progress in research[J]. Journal of Interventional Radiology, 2017, 26(9):855-858. doi:10.3969/j.issn.1008-794X.2017.09.020.
[11]	叶向阳, 汤立新, 程省, 等. 骨密度对骨质疏松性椎体压缩性骨折PKP术后骨折再发风险的评估价值[J]. 中国骨质疏松杂志, 2017, 23(2):154-158.
	YE X Y, TANG L X, CHENG S, et al. Value of bone mineral density on the risk of fracture recurrence after PKP in osteoporotic vertebral compression fractures[J]. Chinese Journal of Osteoporosis, 2017, 23(2):154-158. doi:10.3969/j.issn.1006-7108.2017.02.004.
[12]	REID D M, DEVOGELAER J P, SAAG K, et al. Zoledronic acid and risedronate in the prevention and treatment of glucocorticoid-induced osteoporosis(HORIZON):a multicentre,double-blind,double-dummy,randomised controlled trial[J]. Lancet, 2009, 373(9671):1253-1263. doi:10.1016/S0140-6736(09)60250-6.
[13]	张强, 李文升, 冯良恩, 等. 唑来膦酸对预防腰椎PVP术后再发骨折的疗效评价[J]. 广州医药, 2021, 52(3):52-55.
	ZHANG Q, LI W S, FENG L E, et al. Effect of zoledronic acid on prevention of recurrent fracture after PVP[J]. Guangzhou Medical Journal, 2021, 52(3):52-55. doi:10.3969/j.issn.1000-8535.2021.03.011.
[14]	常青, 史相钦. PKP结合抗骨质疏松药物治疗骨质疏松性椎体压缩性骨折疗效观察[J]. 中国骨与关节损伤杂志, 2015, 30(5):522-523.
	CHANG Q, SHI X Q. Efficacy of PKP combined with anti-osteoporosis drugs in the treatment of osteoporotic vertebral compression fracture[J]. Chinese Journal of Bone and Joint Injury, 2015, 30(5):522-523.
[15]	LI H M, ZHANG R J, GAO H, et al. New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA[J]. Medicine (Baltimore), 2018, 97(40):e12666. doi:10.1097/MD.0000000000012666.

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）
对照组	68	24/44	71.3±8.7	23.91±2.68
唑来膦酸组	84	21/63	68.8±8.5	23.61±2.51
χ²或t		1.898	1.784	0.711
组别	骨折部位（胸椎/腰椎）		PMMA/mL	手术时间/min
对照组	16/52		5.25±1.26	43.65±6.32
唑来膦酸组	22/62		5.21±1.25	43.52±5.62
χ²或t	0.141		0.196	0.134

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）
对照组	68	24/44	71.3±8.7	23.91±2.68
唑来膦酸组	84	21/63	68.8±8.5	23.61±2.51
χ²或t		1.898	1.784	0.711
组别	骨折部位（胸椎/腰椎）		PMMA/mL	手术时间/min
对照组	16/52		5.25±1.26	43.65±6.32
唑来膦酸组	22/62		5.21±1.25	43.52±5.62
χ²或t	0.141		0.196	0.134

组别	n	术前	术后3个月	术后6个月	术后12 个月
对照组	68	-2.70±0.18	-2.73±0.15	-2.75±0.28	-2.84±0.30
唑来膦酸组	84	-2.73±0.15	-2.31±0.22	-2.03±0.18	-1.86±0.37
t		1.937	13.416^＊＊	19.182^＊＊	17.643^＊＊

组别	n	术前	术后3个月	术后6个月	术后12 个月
对照组	68	-2.70±0.18	-2.73±0.15	-2.75±0.28	-2.84±0.30
唑来膦酸组	84	-2.73±0.15	-2.31±0.22	-2.03±0.18	-1.86±0.37
t		1.937	13.416^＊＊	19.182^＊＊	17.643^＊＊

组别	n	术前	术后3个月	术后6个月	术后12个月
对照组	68	7.74±1.56	3.68±2.10	3.09±1.95	2.89±1.95
唑来膦酸组	84	7.58±1.23	2.92±1.24	2.29±1.14	1.81±0.95
t		0.707	2.774^＊	3.154^＊＊	4.466^＊＊

唑来膦酸预防骨质疏松性椎体压缩性骨折术后椎体再发骨折的疗效分析

Analysis of clinical effect of vertebroplasty combined with zoledronate in preventing postoperative recurrence of vertebral fractures

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组别	n	术前	术后3个月	术后6个月	术后12个月
对照组	68	0.46±0.11	0.44±0.07	0.49±0.15	0.48±0.08
唑来膦酸组	84	0.47±0.07	0.15±0.08	0.18±0.04	0.17±0.05
t		0.680	23.485^＊＊	18.173^＊＊	29.178^＊＊

组别	n	术前	术后3个月	术后6个月	术后12个月
对照组	68	42.42±12.96	44.26±8.07	43.59±11.14	42.88±12.16
唑来膦酸组	84	42.34±13.58	17.24±2.55	18.52±2.75	18.62±3.07
t		0.680	28.971^＊＊	19.904^＊＊	17.617^＊＊

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