特立帕肽联合微创手术治疗复杂椎体骨折的初步观察

摘要

目的：评估特立帕肽联合微创手术治疗复杂椎体骨折的近期疗效，探讨特立帕肽治疗严重骨质疏松的适应证和安全性。方法本组共16例患者，均为女性。年龄72～86岁，平均78．5岁。病情特点：患者出现多次椎体骨折或同一椎体一次以上骨折；骨密度检查：均存在严重骨质疏松。本组采用微创手术结合特立帕肽（20ug/日，皮下注射）6个月治疗方案。观察手术前、术后3月、随访6个月时疼痛、骨密度（ BMD）和骨代谢指标变化，同时记录不良事件。结果所有患者手术后疼痛均较术前不同程度缓解（ P＜0．01），特立帕肽治疗6个月后本组未再发生椎体新鲜骨折，患者腰椎骨密度较术前明显增加（ P＜0．05），血清骨钙素（OC）及总Ⅰ型前胶原氨基端延长肽（tPINP）较治疗前显著提高（P＜0．05）；Ⅰ型胶原羧基端β降解产物（β-CTX）较治疗前无统计学差异（P＞0．05）。本组3例患者在注射初期出现肢端疼痛，经对症处理后缓解。未记录到其他严重不良事件。结论对于合并严重骨质疏松的复杂椎体骨折患者，特立帕肽联合微创手术近期疗效满意，明显降低了椎体再发骨折的风险，而且具有较高的安全性。%Objective To evaluate the short-term outcome of patients with complex vertebral fractures treated with teriparatide combined with minimal invasive operation, and to investigate the indication and safety of teriparatide in the treatment of severe osteoporosis.Methods All the 16 patients included in this study were female, aging from 72 to 86 years old, with an average age of 78.5 years old.The patients had multiple vertebral fractures or fractures more than once in the same vertebra.The result of bone mineral density ( BMD) detection suggested the existence of severe osteoporosis.All the patients were treated with 6-month teriparatide (20ug/day, subcutaneous injection) combined with minimal invasive operation.The changes of pain, BMD, and bone metabolism before surgery, 3 months after the operation, and 6 months followed up were observed and compared.The adverse events were also recorded.Results The pain in all patients had relieved to different extent after the operation (P<0.01).After 6-month treatment of teriparatide, no fresh vertebral fracture occurred, and BMD of the lumbar vertebrae increased significantly than that before the operation ( P<0.05 ) .The serum levels of OC and tPINP increased significantly compared with those before the treatment ( P<0.05 ) , while no significant difference of β-CTX before and after the treatment was observed ( P>0.05 ) .Three patients had limb pain at the early stage after injection, and quickly relieved after symptomatic treatment.There was no other adverse reaction.Conclusion Teriparatide combined with minimal invasive operation has been proven as a safe and effective method for the treatment of complex vertebral fractures with severe osteoporosis.The recurrence risk of vertebral fractures reduces obviously.