甲状旁腺激素(1-34)对骨质疏松性腰椎退变性疾病TLIF术后的影响

摘要

Objective To discuss the curative effect of PTH combined with transforaminal lumbar interbody fusion (TLIF) on patients with osteoporosis and lumbar spine degenerative disease and its influence on fusion rate,bone density and bone metabolism.Method 49 cases of elderly patients with osteoporosis and lumbar spine degenerative disease were divided into treatment group and control group at random.The patients in the two groups were given TLIF,while the patients in the test 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 assessed before the operation and 6 months after the operation.Bone mineral density,serum bone human cross linked alkaline phosphatase (BALP),N-telopeptide of type Ⅰ collagen/creatinine (NTX/Cr) were also assessed before and 6 months after the operation.The curative effects on bone density,bone metabolism and fusion rate in patients of two groups were compared.Results The VAS and ODI scores of patients in the two groups 6 months after the operation were all improved compared with before operation (P ＜ 0.05),and the scores of patients in the test group were much lower than those in the control group (P ＜ 0.05).At 6 months postoperatively,bone density and fusion rate of patients in the test group improved compared with before operation (P ＜ 0.05),serum BALP and NTX/Cr increased significantly compared with before operation (P＜ 0.05),and all index were better than the control group (P ＜ 0.05).There were no significant changes appeared in patients of the control group before and after treatment for these index (P ＞ 0.05).Conclusion The application of PTH had favorable curative effect on osteoporosis and lumbar spine degenerative disease after TLIF in elderly patients,and could improve bone density,enhance the serum levels of BALP and NTX/Cr and fusion rate.%目的 探讨甲状旁腺激素(1-34) (PTH)对骨质疏松腰椎退变性疾病经后路椎间孔行腰椎椎间融合术(TLIF)椎间融合率及骨密度、骨代谢的影响.方法 49例老年骨质疏松腰椎退变性疾病患者随机分为实验组和对照组.两组患者均接受TLIF,实验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(0DI);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6个月两组患者VAS与ODI评分均较术前明显改善(P＜0.05),且实验组患者评分明显低于对照组(P＜0.05).术后6个月,实验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).术后6个月试验组椎间融合率明显高于对照组,两组融合率比较差异有统计学意义(P＜0.05).结论 PTH对老年骨质疏松腰椎退变性疾病TLIF术后疗效较好,能增加患者骨密度,提高血清BALP和NTX/Cr水平,增加椎间融合率.