不同剂量伊班膦酸对脊柱手术后骨愈合效果的临床研究

摘要

Objective To investigate the clinical effects of sodium ibondronate treatment on posterior lumbar interbody fusion.Methods Lumbar posterior lumbar interbody fusion was performed in 106 patients which posterior decompression, pedicle screw fixation and interbody fusion were performed.On the basis of postoperative application of ibandronate treatment the patients were divided into experimental group and control group.The experimental group on the basis of ibandronic acid dose was divided into group A and group B.Thirty-five cases in experimental group A used the ibandronate 2 mg by slow intravenous infusion every 3 months and 4 mg in the group B.Thirty-six patients were not treated with bisphosphonates in the control group.The X-ray, CT scan and bone mineral density measurement were performed in all patients before and after surgery and the follow-up.The clinical score, fusion rate, intervertebral height loss and bone mineral density were compared between the 3 groups.Results At last followed-up, the Oswestry dability index(ODI) score and the back visual analogue scale(VAS) score were decreased significantly in group A and group B compared with control individual(P<0.05), and there was no significant differences among 3 groups regarding the low limb pain VAS score(P>0.05).The rate of fusion in experiment group A and group B were significantly higher than that in the control group.Experiment group B were significantly higher than in experiment group A(P<0.05).In addition, the loss of intervertebral height was significant in control group compared with group A and group B(P<0.05).The bone mineral density of lumbar spine and left femur were significantly higher in group A and group B than before treatment and higher than in the control group(P<0.05).Conclusion Ibandronate can effectively promote postoperative posterior lumbar interbody fusion, and help to improve the symptoms of osteoporosis lumbago.The pharmacological effects was dose-related.%目的 探讨不同剂量伊班膦酸对腰椎后路植骨融合术后椎间融合效果的影响.方法 选择行腰后路椎间植骨融合术的腰椎病患者106例,均行后路椎板减压、椎弓根螺钉固定、椎间植骨融合术.依据术后是否应用伊班膦酸钠辅助治疗分为试验组和对照组,试验组依据伊班膦酸的剂量分为试验A组和试验B组.试验A组35例术后每3个月应用伊班膦酸钠2 mg缓慢静脉滴注,试验B组35例术后每3个月应用伊班膦酸钠4 mg缓慢静脉滴注,对照组36例术后不应用任何双膦酸盐类药物.所有患者术前、术后及随访时均行X线、CT扫描及骨密度测量,比较3组临床评分、融合率、椎间高度丢失、骨密度情况.结果 随访时,试验A组和试验B组Oswestry功能障碍指数(Oswestry dability index,ODI)评分、腰痛症状视觉模拟疼痛评分法(visual analogue scale,VAS)评分明显低于对照组(P<0.05),3组下肢疼痛症状VAS评分差异无统计学意义(P>0.05).试验A组和试验B组椎间融合率高于对照组,试验B组椎间融合率高于试验A组(P<0.05).试验A组和试验B组椎间隙高度丢失小于对照组(P<0.05).试验A组和试验B组腰椎骨密度和左股骨粗隆间骨密度明显高于治疗前,且高于对照组(P<0.05).结论 应用伊班膦酸可促进腰椎术后椎间融合,并有利于改善骨质疏松性腰痛症状;药理学效果与剂量相关.