椎体成形术后应用唑来膦酸联合维生素K2治疗老年性椎体压缩骨折

目的观察椎体成形术后应用唑来膦酸联合维生素K2治疗老年性椎体压缩性骨折的3年临床疗效。 方法2013年1月至2015年1月共收治老年性椎体压缩性骨折患者525例，其中女412例，男113例；年龄64～91岁，平均( 79 ± 11)岁。所有患者均予CT引导下椎体成形术手术治疗，术后2～4 d给予唑来膦酸静脉输注，同时补充维生素K2以及钙剂、维生素D。获得术前、术后1周和术后3年腰背痛视觉模拟评分(VAS)评分、Oswestry功能障碍指数(ODI)，术前及术后3年骨密度、骨代谢指标的数据。采用配对样本t检验的方法对术后与术前，术后不同时间获得的各组数据进行统计分析。 结果坚持1年随访为189(36%)人，2年随访为131(25%)人，坚持3年随访的患者为56(10.7%)人，56例中17例为发生再次椎体骨折。经3年随访，患者腰背痛VAS评分(t＝3.01)、ODI评分(t＝0.98)、骨密度同术前比较均有明显改善，且差异有统计学意义(P<0.05) 。骨代谢指标中，骨钙素较术前明显提高(t＝5.75)，β-CTX较术前显著下降(t＝3.06)，差异有统计学意义(P<0. 05)，其他指标变化无统计学差异。 结论老年性椎体压缩性骨折患者长期随访治疗的依从性不高。经过椎体成形术后联合多种抗骨质疏松药物3年的干预治疗，可以明显缓解患者临床症状、改善生活质量、促进骨形成、抑制骨吸收、提高骨密度。

Three-year clinical observation for treating aged vertebral compression fractures combined vertebral plasty with anti-osteoporotic drug

ObjectiveTo observe the clinical curative effect of treatment for senile vertebral compression fractures by vertebral plasty combine with anti-osteoporosis drug for three years. MethodsFrom January 2013 to January 2015, 525 cases of aged vertebral compression fractures were observed, among which 412 were females, 113 were males; aged from 64 to 91 years, the average age was (79±11) years. All the patients accepted percutaneous vertebral plasty surgery guided by CT and C arm X ray, anti-osteoporotic drugs were administrated which included diphosphonate by intravenous infusion in postoperative 2~4 d, calcium, vitamin D and vitamin K2 supplements. The lower back pain visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded preoperatively, one week postoperatively and at the last follow-up.Bone mineral density and bone metabolism index were recorded preoperatively and at the postoperative three-year follow-up. Paired t test was used to analyze the data of each group obtained at different time after the surgery and before the surgery. ResultsThere were 189 (36%) patients came back for one year follow-up, 131 (25%) for two-year follow-up, only 56 patients (10.7%) insisted three-year follow-up. Among these 56 patients, 17 cases occurred vertebral fracture again. After three-year follow-up, the lower back pain VAS score(t=3.01), ODI score(t=0.98), bone mineral density improved compared with preoperative ones, and the differences were statistically significant (P<0.05). As for the bone metabolism index, the osteocalcin (OC) increased(t=5.75) and the β-CTX decreased(t=3.06) compared with preoperative ones, the differences were significant statistically (P<0.05), while the other indicators showed no statistical difference. ConclusionsFor the long-term follow-up, the treatment compliance of senile patients with vertebral compression fractures is not optimistic. After three-year treatment of vertebral plasty combined with anti-osteoporotic drug for aged vertebral compression fractures patient, the treatment can obviously relieve patients' clinical symptoms, improve quality of life, promote bone formation, inhibit bone resorption and improve bone mineral density.