伊班磷酸钠在多发性老年骨质疏松性脊柱骨折术后的应用

目的 探讨多发性老年骨质疏松性脊柱骨折术后应用伊班膦酸钠的疗效及安全性.方法 选取2013年1月至2015年1月在我院骨科确诊为多发性老年骨质疏松脊柱骨折术后患者90例,根据入院顺序采用随机数字法分为A、B、C三组,每组30例.A组患者只给予钙尔奇D (碳酸钙D3片) 0.6 g,Qd口服和珍牡肾骨0.63 g, Tid口服,B组患者在A组治疗的基础上于术后1周给予伊班磷酸钠注射液2 mg静脉滴注,C组患者则在术后1个月给予伊班磷酸钠注射液2 mg静脉滴注,伊班磷酸钠注射液连续2 d,每3个月静脉滴注1次,随访治疗6个月.期间应用视觉模拟疼痛评分(VAS)对患者疼痛进行定期评价,测定治疗前后患者的骨形成指标碱性磷酸酶(ALP)和骨吸收指标抗酒石酸酸性磷酸酶-5b (TPACP-5b)以及血钙和血磷水平、腰椎、股骨颈的骨密度.结果 治疗前三组患者各项观察指标比较差异均无统计学意义(P>0.05);治疗后1周,B组VAS评分、ALP和TRACP-5b降低幅度明显(P<0.05),A组和C组降低幅度不明显(P>0.05);治疗后3个月和6个月后,B、C组均比治疗前明显降低,且B组最显著(P<0.05);治疗后三组腰椎(L2~4)及股骨颈处的BMD、血钙和血磷较治疗前均有不同程度的升高,B组骨密度提高最明显,C组次之,B组血钙和血磷的提高最明显,C组次之(P<0.05),A组提高不明显(P>0.05);B组骨折基本愈合最快;C组次之,A组最慢,且三组比较差异均具有统计学意义(P<0.05);A组的内固定失败例数与骨折复发例数最多, C组次之,B组最好,且三组比较差异均具有统计学意义(P<0.05).结论 术后伊班膦酸钠间断静脉给药能有效地缓解疼痛,促进骨生化指标的尽早恢复,增加老年骨质疏松症患者的骨密度,缩短骨折愈合时间,并减少骨质疏松性骨折复发的概率,且在术后1周内尽早给药,明显优于晚期给药的治疗效果.

Application of ibandronate in elderly patients with multiple osteoporotic spinal fractures after operation

Objective To discuss the efficacy and safety of applying ibandronate post-operatively in elderly pa-tients with multiple osteoporotic spinal fractures. Methods Ninety elderly postoperative patients of multiple osteoporot-ic spinal fractures from Jan. 2013 to Jan. 2015 were selected and randomly divided into group A, group B, group C, with 30 patients in each group. Patients of three groups were all treated with oral Caltrate D (calcium carbonate D3 tablets) 0.6 g, Qd and oral Zhenmu Shengu Jiaonang 0.63 g, Tid. Patients of group B were treated additionally with intravenous drip in-fusion of ibandronate injection 2 mg after one week, and the patients of group C were additionally given ibandronate in-jection 2 mg after one month, for two consecutive days every three months. The patients were followed-up for six months. The pains of patients were given regular assessment by Visual Analogue Scale (VAS). Bone formation index, al-kaline phosphatase (ALP) and bone resorption index tartrate-resistant acid phosphatase 5b (TPACP-5b) of patients were detected before and after treatment, as well as serum calcium, serum phosphate, bone mineral density of lumbar vertebra and femoral neck. Results The indexes showed no statistically significant difference between the three groups before treatment (P>0.05). One week after treatment, VAS score, ALP, TRACP-5b decreased significantly in group B (P<0.05), but showed no significant decrease in group A and group C (P>0.05). Three months and six months after treatment, VAS score, ALP, TRACP-5b all decreased significantly in the three groups compared with before treatment, especially in group B (P<0.01). The BMD at the L2~4 lumbar vertebra and neck of femur, blood calcium, and blood phosphate after treatment were increased to different degree in the three groups. The increase was the most significant in group B, followed by group C (P<0.05), and the increase in group A was not significant (P>0.05). The healing of fracture in group B was the fastest, followed by group C and then group A, with statistically significant difference between the three groups (P<0.05). The cases for unsuccessful internal fixation and recurrence were the most in group A, followed by group C and then group B, with statistically significant difference between the three groups (P<0.05). Conclusion Postoperative intermit-tent intravenous infusion of ibandronate can effectively relieve pain, promote the early recovery of bone biochemical in-dexes, increase the BMD of elderly patients with osteoporosis, shorten fracture healing time, and reduce the risk of recur-rence of osteoporotic fractures. The clinical efficacy is better when ibandronate is given within one week after surgery.