| 唑来膦酸联合维生素K2在经皮椎体成形术治疗多节段骨质疏松性椎体压缩骨折中的临床应用 |
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投稿时间：2019-08-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 黄岩石 |
HUANG Yan |
南阳市第二人民医院骨三科, 河南 南阳 473000 |
The Third Department of Orthopaedics, the Second People's Hospital of Nanyang, Nanyang 473000, Henan, China |
hyanshi@163.com |
| 吴迪 |
WU Di |
南阳市第二人民医院骨三科, 河南 南阳 473000 |
The Third Department of Orthopaedics, the Second People's Hospital of Nanyang, Nanyang 473000, Henan, China |
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| 期刊信息：《中国骨伤》2020年，第33卷，第9期，第820-826页 |
| DOI：10.12200/j.issn.1003-0034.2020.09.006 |
| 基金项目: |
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中文摘要:目的：探究唑来膦酸联合维生素K2方案在经皮椎体成形术治疗多节段骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures，OVCFs）中的临床应用效果。
方法：选取自2014年1月至2017年1月收治入脊柱外科的364例OVCFs患者为研究对象，根据术后是否采用唑来膦酸联合维生素K2抗骨质疏松治疗方案分成两组（对照组和试验组）。其中对照组257例患者采用碳酸钙和维生素D方案，试验组107例患者在对照组基础上加用唑来膦酸联合维生素K2方案。统计并比较两组患者的疼痛视觉模拟评分（visual analogue scale，VAS），Oswestry功能障碍指数（Oswestry Disability Index，ODI），术前和术后腰椎和股骨近端骨密度，责任椎体的椎高比，椎体Cobb角，骨代谢相关血清学指标，以及术后发热、头晕、骨关节痛、肌肉软组织疼痛和相邻椎体再骨折等不良反应发生率。
结果：两组患者一般资料差异无统计学意义（P<0.05）。两组患者术前和术后24 h VAS评分比较差异无统计学意义（P>0.05）；术后1、3个月和术后1年的VAS评分比较，试验组明显低于对照组（P<0.05）。两组术前ODI比较差异无统计学意义（P>0.05）；术后24 h、3个月、1年ODI比较，试验组均明显低于对照组（P<0.05）。两组术前责任椎体的椎高比和Cobb角差异无统计学意义（P>0.05），术后3个月、1年责任椎体的椎高比比较，试验组明显高于对照组（P<0.05）。术后3个月和术后1年Cobb角比较，试验组明显低于对照组（P<0.05）。两组术前腰椎骨密度和股骨近端骨密度比较差异无统计学意义（P>0.05）；术后3个月、1年的腰椎骨密度和股骨近端骨密度比较，试验组明显低于对照组（P<0.05）。试验组和对照组骨代谢标志物如总Ⅰ型胶原氨基端延长肽、β-胶原降解产物和25羟基维生素D术前含量比较差异无统计学意义（P>0.05）；术后1年两组总Ⅰ型胶原氨基端延长肽、β-胶原降解产物比较，试验组明显低于对照组（P<0.05）。试验组术后1年25羟基维生素D明显高于对照组（P<0.05）。试验组术后并发症如发热、头晕、骨关节痛、肌肉软组织疼痛和相邻椎体再骨折等不良反应发生率明显低于对照组（P<0.05）。
结论：唑来膦酸注射液联合维生素K2方案可以用于OVCFs椎体成形术的抗骨质疏松治疗，疗效肯定，安全系数高，值得推广。 |
| 【关键词】唑来膦酸 维生素K2 经皮椎体成形术 骨质疏松性椎体压缩骨折 |
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| Clinical application of zoledronic acid combined with vitamin K2 in percutaneous vertebroplasty for multi-segment osteoporotic vertebral compression fractures |
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ABSTRACT Objective: To explore the clinical effect of zoledronic acid combined with vitamin K2 regimen in percutaneous vertebroplasty for multi-segment osteoporotic vertebral compression fractures (OVCFs).
Methods: This study was a retrospective control study. A total of 364 patients with OVCFs who were admitted to our spinal surgery department from January 2014 to January 2017 were selected as the study subjects. According to whether zoledronic acid combined with vitamin K2 was used to treat osteoporosis after surgery,the patients were divided into control group and experimental group. Among them,257 patients in the control group were treated with calcium carbonate and vitamin D regimen,while 107 patients in the experimental group were treated with zoledronic acid combined with vitamin K2 regimen on the basis of the control group. Visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were used to evaluate the clinical effect. Pre-and post-operative bone mineral density of lumbar spine and proximal femur,vertebral height ratio of responsible vertebral body and Cobb angle of vertebral body were observed by image data. Serological indicators related to bone metabolism were detected by laboratory. The complications such as fever,dizziness,osteoarthritis,muscular and soft tissue pain and adjacent vertebral re-fracture were compared between two groups.
Results: There was no significant difference in general data between the two groups (P<0.05). There was no significant difference in VAS score between experimental group and control group before and 24 hours after operation (P>0.05);VAS score in the experimental group was significantly lower than that in the control group 1 month,3 months and 1 year after operation (P<0.05). There was no significant difference in ODI between two groups before operation (P>0.05),and at the 24 hours,3 months,1 year after operation,the experimental group was significantly lower than the control group (P<0.05). There was no significant difference in the vertebral height ratio of the responsible vertebral body and the Cobb angle before operation between two groups (P>0.05). The vertebral height ratio of the responsible vertebral body in experimental group was significantly higher than that in control group and Cobb angle in experimental group was significantly lower than that in control group at 3 months and 1 year after operation (P<0.05). There was no significant difference in preoperative bone mineral density of lumbar spine and proximal femur between two groups (P>0.05),but at 3 months and 1 year after operation,the bone mineral density of lumbar spine and proximal femur in experimental group was significantly lower than that in control group (P<0.05). There was no significant difference in preoperative bone metabolic markers such as total type I collagen amino-terminal elongation peptide,β-collagen degradation products and 25-hydroxyvitamin D between two groups (P>0.05). At 1 year after operation the total type I collagen amino-terminal elongation peptide and β-collagen degradation products in experimental group was significantly lower than that in the control group (P<0.05),but the 25-hydroxyvitamin D operation in experimental group was significantly higher than that in control group (P<0.05). The incidence of postoperative complications such as fever,dizziness,osteoarthritis,muscle and soft tissue pain and adjacent vertebral re-fracture in experimental group was significantly lower than that in control group (P<0.05).
Conclusion: Zoledronic acid injection combined with vitamin K2 regimen can be used for anti-osteoporosis treatment of OVCFs vertebroplasty. It has a definite curative effect and a high safety factor. It is worth popularizing. |
| KEY WORDS Zoledronic acid Vitamin K2 Percutaneous vertebroplasty Osteoporotic vertebral compression fractures |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 黄岩石,吴迪.唑来膦酸联合维生素K2在经皮椎体成形术治疗多节段骨质疏松性椎体压缩骨折中的临床应用[J].中国骨伤,2020,33(9):820~826 |
| 英文格式: | HUANG Yan,WU Di.Clinical application of zoledronic acid combined with vitamin K2 in percutaneous vertebroplasty for multi-segment osteoporotic vertebral compression fractures[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(9):820~826 |
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