甲状旁腺激素(1-34)联合PKP对老年骨质疏松椎体压缩性骨折患者疗效观察

摘要

目的 探讨甲状旁腺激素(1-34) (PTH)联合经皮椎体后凸成形术(PKP)治疗老年骨质疏松椎体压缩性骨折的疗效及对患者骨密度、骨代谢的影响.方法 87例老年压缩性骨折患者随机分为治疗组和对照组.两组患者均接受PKP,治疗组术后第一天开始每天皮下注射20 μg PTH一次.分别在术前、术后24 h、术后6个月评定两组患者视觉模拟疼痛评分(VAS)及Oswestry功能障碍指数评分(ODI);术前与术后6个月检测患者骨密度及骨碱性磷酸酶骨人交联碱性磷酸酶(BALP),Ⅰ型胶原N末端肽/肌酐(Ⅰ型胶原N-端肽)肌酸酐(NTX/Cr).结果 术后24 h、6个月两组患者VAS与ODI评分均较术前明显改善(P＜0.05),且治疗组患者评分明显低于对照组(P＜0.05).术后6个月,治疗组患者腰椎骨密度较术前显著改善(P＜0.05),血清BALP和NTX/Cr较术前明显上升(P＜0.05),且均明显优于对照组(P＜0.05);而对照组治疗前后上述指标无明显变化(P＞0.05).结论 PTH联合PKP治疗老年椎体压缩性骨折疗效较好,能增加患者骨密度,提高血清BALP和NTX/Cr水平,安全性好.%Objective To discuss the curative effect of parathyroid hormone (PTH) (1-34) combined with percutaneous kyphoplasty (PKP) on osteoporotic vertebral compression fractures in elderly patients and its influence on bone density and bone metabolism.Methods 87 cases of elderly patients with osteoporotic vertebral compression fractures were divided into treatment group and control group at random.The patients in the two groups were given PKP,while the patients in tthe treatment group were additionally given 20 μg PTH everyday by subcutaneous injection from the first day after operation.The visual analogue scale (VAS) and Oswestry disability index score (ODI) were recorded before the operation,and at 24 hours and 6 months after the operation.Bone mineral density and serum bone alkaline phosphatase (BALP) and N-telopeptide of type I collagen/creatinine (NTX/ Cr) were measured before and 6 months after the operation.The curative effect,bone density and bone metabolism of patients in the two groups were compared.Results The VAS and ODI scores of patients in the two groups at 24 hours and 6 months after the operation were all improved compared with before operation (P ＜ 0.05),with the scores of patients in the treatment group significantly lower than those in the control group (P ＜ 0.05).At 6 months postoperatively,bone density of patients in the treatment group improved compared with before treatment (P ＜ 0.05),and serum BALP and NTX/ Cr increased significantly compared with before operation (P ＜ 0.05),with all index better than the control group (P ＜ 0.05).There were no significant changes in patients in the control group before and after treatment (P ＞ 0.05).Conclusion The application of PTH combined with PKP had favorable curative effect on osteoporotic vertebral compression fractures in elderly patients,could improve bone density and enhance the serum levels of BALP and NTX/ Cr,and it was safe.