双膦酸盐和甲状旁腺激素对骨质疏松性椎体压缩骨折手术后的影响

摘要

目的 探讨双膦酸盐和甲状旁腺激素对骨质疏松性椎体压缩骨折(OVCF)手术后的影响.方法 前瞻性选取120例2013年4月至2017年8月入院进行治疗的OVCF患者,将120例患者随机分成四组,即对照组、唑来膦酸组、特立帕肽组和唑来膦酸联合特立帕肽组.在对所有患者进行椎体成形术(PVP)后分别给予四组患者钙尔奇、唑来膦酸、特立帕肽、唑来膦酸联合特立帕肽进行治疗.观察四组患者用药后的疗效、视觉模拟疼痛评分(VAS)、Oswestry功能障碍指数(ODI)、骨密度(BMD)、血清I型前胶原N末端前肽(PINP)、I型胶原C末端肽(CTX-1)和不良反应.结果 经4种用药方式治疗后的OVCF患者在治疗后均可显著提高患者术后愈合效果(P＜0.05).与对照组相比,特立帕肽组患者治疗后VAS评分较治疗前显著降低(P＜0.05),同时HPN和CTX值也显著降低,唑来膦酸组患者的ODI分值者显著降低(P＜0.05),其中经唑来膦酸组联合特立帕肽治疗组的疗效最好,与其他几组比较差异最显著(P＜0.01).唑来膦酸组、特立帕肽组和联合用药组在年龄、性别和骨折时间的用药效果在VAS、ODI、RMD、PIPN、CTX值差异无显著性(P＞0.05).药物安全性研究发现,唑来膦酸和特立帕肽仅引起少数患者发生中度或重度的反胃、心悸、头痛或眩晕等症状,肝肾功能均未出现异常.结论 与单独药物组比较,PVP术后采用特立帕肽联合唑来膦酸治疗OVCF的效果最好,能够显著降低患者疼痛以及骨转换标志物的浓度,提高患者生活质量和骨密度,且不良反应较少.%Objective To investigate the effect of bisphosphonates and parathyroid hormone on ostcoporotic vertebral compression fractures.Methods 120 cases of patients with OVCF from April 2013 to August 2017 admitted to hospital for treatmen were randomly divided into 4 groups:control group,zoledronic acid group,teriparatide group and zoledronic acid combined with teriparatide group.All the patients underwent percutaneous vertebroplasty (PVP),and patients were given Caltrate,zoledronic acid,teriparatide,zoledronic acid combined with teriparatide treatment,respectively.The efficacy,visual analog pain score (VAS),Oswestry dysfunction index (ODI),bone mineral density (BMD),serum type Ⅰ procollagen N-terminal propeptide (PINP),type Ⅰ collagen C-terminal peptide (CTX-1) and adverse reactions of four groups of patients after treatment were compared.Results After treatment with 3 kinds of drugs,the healing effect after the treatment of OVCF patients was significantly improved (P ＜ 0.05).Compared with the control group,VAS score in teriparatide group after treatment was significantly lower than that before treatment (P ＜ 0.05),while PIPN and CTX value were significantly decreased,Zoledronic acid scores of patients with ODI were significantly lower (P ＜0.05),zoledronic acid combined teriparatide treatment group had the best therapeutic effect with significant difference (P ＜ 0.01).the effect of medication on age and sex and fracture time in VAS,ODI,RMD,PIPN and CTX in zoledronic acid group,teriparatide group and combination group had no significant differences (P ＞ 0.05).Study on the safety of drug showed that,zoledronic acid and teriparatide caused only a few patients moderate or severe nausea,palpitation,headache or dizziness and other symptoms,liver and kidney function were not abnormal.Conclusion Teriparatide combined with zoledronic acid in the treatment of OVCF had the best effect of phosphine,can significantly reduce the pain of patients and the concentration of markers of bone turnover,improve the quality of life and bone mineral density in patients with dystroph.