【摘要】：目的觀察經(jīng)皮球囊擴張椎體成形術(shù)(PKP)聯(lián)合靜滴唑來膦酸治療老年骨質(zhì)疏松性椎體壓縮性骨折(OVCF)的療效及超前預(yù)防性使用非甾體消炎鎮(zhèn)痛藥西樂葆對靜滴唑來膦酸后急性期不良反應(yīng)(APR)的預(yù)防治療效果。方法回顧性分析武漢市普愛醫(yī)院于2010年1月至2013年12月采用單側(cè)PKP術(shù)治療單節(jié)段老年骨質(zhì)疏松性椎體壓縮性骨折并獲得1年以上隨訪的患者116例,根據(jù)患者術(shù)后是否應(yīng)用唑來膦酸(密固達)分為A(試驗組,67例)、B(對照組,49例)兩組,其中A組PKP術(shù)后3d使用唑來膦酸,根據(jù)是否在靜滴唑來膦酸前3d給予西樂葆口服,又將A組分為C(非西樂葆組,30例)、D(西樂葆組,37例)兩組。分別測量A組和B組患者術(shù)前及術(shù)后1年的骨密度,對PKP術(shù)后鄰近椎體骨折(AVF)的發(fā)生率進行統(tǒng)計,術(shù)前、術(shù)后隨訪時采用疼痛視覺模擬評分(VAS)評估疼痛程度,采用Oswestry評分評估活動能力,并對骨折椎體高度及Cobb角變化進行分析,評估PKP聯(lián)合唑來膦酸治療老年骨質(zhì)疏松性椎體壓縮性骨折的療效。同時觀察C組和D組APR的發(fā)生率,發(fā)熱程度及肌肉骨骼疼痛程度的差異,評估超前預(yù)防性使用西樂葆對靜滴唑來膦酸后APR的預(yù)防效果。結(jié)果治療1年后A組患者股骨近端骨密度明顯提高,治療后1年內(nèi)無新發(fā)椎體骨折的發(fā)生,B組術(shù)后1年期間有脊柱骨性疼痛加重趨勢,隨訪期間新發(fā)椎體骨折10例,其中新發(fā)AVF 6例。兩組患者術(shù)后傷椎椎體高度、Cobb角、VAS評分和Oswestry評分均較術(shù)前明顯改善,差異有統(tǒng)計學(xué)意義(均P0.05),但術(shù)后兩組間比較無顯著性差異。C組和D組APR發(fā)生率、發(fā)熱及肌肉骨骼疼痛程度差異均有統(tǒng)計學(xué)意義(均P0.01)。兩組患者均無其它不良反應(yīng)發(fā)生。結(jié)論唑來膦酸聯(lián)合PKP技術(shù)治療老年骨質(zhì)疏松性骨折效果顯著,可明顯提高骨質(zhì)疏松性患者骨密度,預(yù)防骨量持續(xù)丟失,提高患者生活質(zhì)量,并有效減輕全身及脊柱骨性疼痛癥狀,預(yù)防再次骨折的發(fā)生,可作為骨質(zhì)疏松性骨折PKP術(shù)后一種有效的輔助治療措施。超前預(yù)防性使用非甾體消炎鎮(zhèn)痛藥西樂葆可大大降低靜滴唑來膦酸后急性期不良反應(yīng)的發(fā)生率及發(fā)熱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.
【作者單位】： 華中科技大學(xué)同濟醫(yī)學(xué)院附屬武漢市普愛醫(yī)院脊柱外科;
【基金】：衛(wèi)生部衛(wèi)生行業(yè)專項項目(No.W2014ZT294)
【分類號】：R580;R687.3

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