Effect of zoledronic acid combined with percutaneous vertebroplasty on osteoporotic compression fractures in the elderly patients
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摘要:
目的 探讨唑来膦酸对老年性骨质疏松椎体压缩骨折患者椎体成形术后骨密度、骨代谢的影响，为临床治疗提供依据。 方法 选取2019年1月—2019年12月在宜春市人民医院骨科应用经皮椎体成形术治疗的老年骨质疏松椎体压缩性骨折患者92例，采用数字随机法将92例患者分为对照组和治疗组，对照组48例，治疗组44例。对照组患者行椎体成形术后给予骨化三醇联合维生素D治疗；治疗组患者行椎体成形术后给予骨化三醇、维生素D及唑来膦酸治疗。比较2组患者治疗前、治疗后的VAS评分及Oswestry功能障碍指数评分(ODI)；并比较2组患者治疗前、治疗后的腰椎骨密度及骨钙素(BGP)指标变化。 结果 所有患者均顺利完成椎体成形手术。治疗前，2组患者VAS、ODI、腰椎骨密度、骨钙素差异均无统计学意义(均P＞0.05)；治疗后，2组患者VAS、ODI均明显下降(均P＜0.05)，且治疗组明显优于对照组(均P＜0.05)。治疗前，2组患者腰椎骨密度、血清骨钙素差异无统计学意义(均P＞0.05)；治疗后，2组患者腰椎骨密度、血清骨钙素均明显升高(均P＜0.05)，且治疗组明显优于对照组(均P＜0.05)。 结论 唑来膦酸联合椎体成形术治疗老年骨质疏松椎体压缩性骨折疗效良好，能有效改善患者骨质疏松症状，提高患者骨密度及骨代谢指标。 Abstract:Objective To explore the effect of zoledronic acid on bone mineral density and bone metabolism in elderly patients with osteoporotic vertebral compression fracture after vertebroplasty providing basis for clinical treatment. Methods From January 2019 to December 2019, a total of 92 elderly patients with osteoporotic vertebral compression fractures in the People's Hospital of Yichun City were selected, and divided into treatment group (44 cases) and control group (48 cases) according to the random number table method. All the patients in the two groups received percutaneous vertebroplasty treatment. The patients in the control group were treated with calcitriol and vitamin D after the percutaneous vertebroplasty, and the patients in the treatment group were additionally given zoledronic acid. The visual analogue scale (VAS) and Oswestry disability index score (ODI) were recorded. Bone mineral density and serum bone Gla-protein (BGP) were assessed before and after the treatment. Results All patients successfully completed the percutaneous vertebroplasty operation. The VAS, ODI, lumbar vertebral bone density and serum osteocalcin were not significantly different between the two groups before the treatment (all P>0.05). The VAS and ODI scores of patients in the two groups after the treatment were all improved (all P < 0.05), the difference between the two groups was statistically significant (all P < 0.05). At the last follow-up, lumbar vertebral bone density and serum osteocalcin were significantly increased in both groups (all P < 0.05), and the treatment group was significantly better than the control group (all P < 0.05). Conclusion The application of zoledronic acid combined with percutaneous vertebroplasty has favorable curative effect on osteoporotic vertebral compression fractures in elderly patients, and could improve the symptoms of osteoporosis, the bone density and bone metabolism indexes of patients. -
表 1 2组老年骨质疏松性椎体压缩骨折患者一般情况比较
(x ±s) 组别 例数 性别(例) 平均年龄
(岁)随访时间
(月)男性 女性 治疗组 48 25 23 72.56±3.24 24.29±4.24 对照组 44 23 21 70.82±6.08 23.89±7.55 统计量 0.513a 0.461b 0.488b P值 0.812 0.772 0.610 注：a为χ2值，b为t值。 
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表 2 2组老年骨质疏松性椎体压缩骨折患者VAS评分结果
(x ±s，分) 组别 例数 VAS评分 t值 P值 治疗前 治疗后 治疗组 48 8.22±1.31 2.25±1.19 68.625 ＜0.001 对照组 44 8.09±1.22 2.89±2.46 40.562 ＜0.001 t值 0.147 9.882 P值 0.223 ＜0.001
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表 3 2组老年骨质疏松性椎体压缩骨折患者ODI评分结果
(x ±s，分) 组别 例数 ODI评分 t值 P值 治疗前 治疗后 治疗组 48 74.48±14.24 21.28±17.05 27.891 ＜0.001 对照组 44 75.37±16.92 24.19±10.66 18.639 ＜0.001 t值 0.126 8.812 P值 0.158 ＜0.001
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表 4 2组老年骨质疏松性椎体压缩骨折患者腰椎骨密度结果
(x ±s，g/cm2) 组别 例数 腰椎(L1~4) t值 P值 治疗前 治疗后 治疗组 48 0.69±0.08 0.83±0.37 5.849 0.014 对照组 44 0.68±0.11 0.81±0.46 3.716 0.022 t值 0.418 2.253 P值 0.652 ＜0.001
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表 5 2组老年骨质疏松性椎体压缩骨折患者骨钙素结果
(x ±s，ng/mL) 组别 例数 骨钙素 t值 P值 治疗前 治疗后 治疗组 48 5.58±0.35 10.15±1.92 22.145 ＜0.001 对照组 44 5.54±0.44 8.22±1.07 16.272 ＜0.001 t值 0.426 7.298 P值 0.261 ＜0.001
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