经皮椎体后凸成形术联合辛伐他汀治疗脊柱压缩性骨折的临床疗效分析
|
摘要
目的通过经皮椎体后凸成形术(PKP)联合辛伐他汀治疗脊柱压缩性骨折患者,探究其临床疗效以及对患者骨密度的影响,旨在为临床治疗提供参考。方法南京市中西医结合医院骨二科2014年10月—2016年10月收治96例椎体压缩骨折患者,根据随机数字表法分为PKP治疗组和PKP联合辛伐他汀治疗组,每组48例。比较两组患者治疗前后ODI、VAS评分,椎体高度、Cobb角及骨密度以及两组患者椎体骨折再发率与不良反应的发生率。结果两组术后12个月内无随访脱落。治疗后,两组的ODI与VAS评分均较治疗前显著降低(P<0.05),且PKP联合辛伐他汀治疗组ODI、VAS评分改善程度显著优于PKP治疗组(t=12.142,P=0.000;t=7.891,P=0.000);治疗后,两组椎体高度与Cobb角均显著降低(P<0.05),但组间比较差异无统计学意义(P>0.05);治疗后,两组骨密度均显著升高(P<0.05),且PKP联合辛伐他汀治疗组骨密度显著高于PKP治疗组(t=14.908,P=0.000);治疗后,两组椎体骨折再发率分别为4.17%、18.75%,差异有统计学意义(χ~2=5.031,P=0.025);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论 PKP联合辛伐他汀治疗脊柱压缩性骨折患者,不仅能够有效止痛,恢复脊柱功能,还可以提高患者骨密度,降低再次骨折的发生率,值得进一步推广。
Objective To observe the effect of PKP combined with Simvastatin on the treatment of spinal compression fracture and its effect on bone density. Methods From Oct. 2014 to Oct. 2016,a total of 96 patients with spinal compression fracture were selected as the research object in our hospital,and randomly divided into observation group and control group(48 cases in each group). The patients in the control group were given PKP,and the patients in the observation group were given PKP plus Simvastatin. The ODI scores,VAS scores,vertebral height,Cobb's angle and bone mineral density were compared between the two groups before and after treatment,and the rate of recurrence and adverse reactions of vertebral fracture were compared between the two groups. Results After treatment,both ODI scores and VAS scores of the two groups were significantly decreased(P<0.05),and the improvement of ODI score and VAS score in the observation group were significantly better than those in the control group(t=12.142,P=0.000; t=7.891,P=0.000). After treatment,both vertebral height and Cobb's angle decreased significantly(P<0.05),but there was no significant difference between the two groups(P>0.05).After treatment,the bone mineral density of both groups increased significantly(P<0.05),and the bone density of the observation group was significantly higher than that in the control group(t=14.908,P=0.000).After treatment,the recurrence rate of vertebral fracture in the observation group and control group was 4.17% and 18.75%, respectively,and the observation group was significantly lower than that of the control group(χ~2=5.031,P=0.025). There was no significant difference between the two groups(P>0.05). Conclusion The combined treatment of PKP and Simvastatin can effectively relieve pain,restore spinal function,improve bone mineral density,and reduce the recurrence rate of vertebral fracture,which is valuable in clinical application.
Objective To observe the effect of PKP combined with Simvastatin on the treatment of spinal compression fracture and its effect on bone density. Methods From Oct. 2014 to Oct. 2016,a total of 96 patients with spinal compression fracture were selected as the research object in our hospital,and randomly divided into observation group and control group(48 cases in each group). The patients in the control group were given PKP,and the patients in the observation group were given PKP plus Simvastatin. The ODI scores,VAS scores,vertebral height,Cobb's angle and bone mineral density were compared between the two groups before and after treatment,and the rate of recurrence and adverse reactions of vertebral fracture were compared between the two groups. Results After treatment,both ODI scores and VAS scores of the two groups were significantly decreased(P<0.05),and the improvement of ODI score and VAS score in the observation group were significantly better than those in the control group(t=12.142,P=0.000; t=7.891,P=0.000). After treatment,both vertebral height and Cobb's angle decreased significantly(P<0.05),but there was no significant difference between the two groups(P>0.05).After treatment,the bone mineral density of both groups increased significantly(P<0.05),and the bone density of the observation group was significantly higher than that in the control group(t=14.908,P=0.000).After treatment,the recurrence rate of vertebral fracture in the observation group and control group was 4.17% and 18.75%, respectively,and the observation group was significantly lower than that of the control group(χ~2=5.031,P=0.025). There was no significant difference between the two groups(P>0.05). Conclusion The combined treatment of PKP and Simvastatin can effectively relieve pain,restore spinal function,improve bone mineral density,and reduce the recurrence rate of vertebral fracture,which is valuable in clinical application.
引文
[1] 郭永智,王洋,徐宇航,等.老年骨质疏松性椎体压缩性骨折[J].北京医学,2017,39(2):126-128.
[2] Bozkurt M,Kahilogullari G,Ozdemir M,et al.Comparative analysis of vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures[J].Asian Spine J,2014,8(1):27-34.
[3] Clouthier AL,Hosseini HS,Maquer G,et al.Finite element analysis predicts experimental failure patterns in vertebral bodies loaded via intervertebral discs up to large deformation[J].Med Eng Phys,2015,37(6):599-604.
[4] 刘晓宁,孔德明,肖继龙,等.辛伐他汀对桡骨远端骨折老年女性骨密度及骨折愈合的影响[J].中国骨质疏松杂志,2017,23(1):74-77.
[5] 印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.
[6] Haegg O.Oswestry disability index.[J].J Neurosurg Spine,2014,20(2):241-242.
[7] Price DD,Mcgrath PA,Rafii A,et al.The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.[J].Pain,1983,17(1):45-56.
[8] 刘璠.骨质疏松性骨折的流行病学研究进展[J].国际老年医学杂志,2015,24(4):174-178.
[9] 张国华,杜伟,罗鹏明,等.PVP与PKP治疗骨质疏松脊柱压缩性骨折的临床治疗效果比较[J].现代生物医学进展,2017,17(5):909-912.
[10] Ren H,Wang J,Chen J,et al.Clinical efficacy of unipedicular versus bipedicular percutaneous vertebroplasty for Kummell’s disease[J].J Southern Med University,2014,34(9):1370-1374.
[11] Kim YC,Kim YH,Ha KY.Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine.[J].Spine J,2013,14(4):659-666.
[12] 李蒙,李磊,徐磊,等.PKP术后相邻椎体再骨折的相关因素分析[J].中国骨与关节损伤杂志,2017,32(7):692-694.
[13] Gradosovaabaaaa I.Protective effect of atorvastatin on bone tissue in orchidectomised male albino Wistar rats[J].Euro J Pharmacol,2012,679(1-3):144-150.
[14] 王慧,罗晓晋,武锋.辛伐他汀与Bio-Oss骨粉混合物对种植体周围缺损骨重建中破骨细胞的作用[J].中国药物与临床,2013,13(4):434-436.
[15] Chen XY,Li K,Alan R Light,et al.Simvastatin attenuates formalin-induced nociceptive behaviors by inhibiting microglial RhoA and p38 MAPK activation[J].J Pain,2013,14(11):1310-1319.
[16] Wang H,Sribastav SS,Ye F,et al.Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures:a meta-analysis of the literature[J].Pain Physician,2015,18(3):209-222.
[2] Bozkurt M,Kahilogullari G,Ozdemir M,et al.Comparative analysis of vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures[J].Asian Spine J,2014,8(1):27-34.
[3] Clouthier AL,Hosseini HS,Maquer G,et al.Finite element analysis predicts experimental failure patterns in vertebral bodies loaded via intervertebral discs up to large deformation[J].Med Eng Phys,2015,37(6):599-604.
[4] 刘晓宁,孔德明,肖继龙,等.辛伐他汀对桡骨远端骨折老年女性骨密度及骨折愈合的影响[J].中国骨质疏松杂志,2017,23(1):74-77.
[5] 印平,马远征,马迅,等.骨质疏松性椎体压缩性骨折的治疗指南[J].中国骨质疏松杂志,2015,21(6):643-648.
[6] Haegg O.Oswestry disability index.[J].J Neurosurg Spine,2014,20(2):241-242.
[7] Price DD,Mcgrath PA,Rafii A,et al.The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.[J].Pain,1983,17(1):45-56.
[8] 刘璠.骨质疏松性骨折的流行病学研究进展[J].国际老年医学杂志,2015,24(4):174-178.
[9] 张国华,杜伟,罗鹏明,等.PVP与PKP治疗骨质疏松脊柱压缩性骨折的临床治疗效果比较[J].现代生物医学进展,2017,17(5):909-912.
[10] Ren H,Wang J,Chen J,et al.Clinical efficacy of unipedicular versus bipedicular percutaneous vertebroplasty for Kummell’s disease[J].J Southern Med University,2014,34(9):1370-1374.
[11] Kim YC,Kim YH,Ha KY.Pathomechanism of intravertebral clefts in osteoporotic compression fractures of the spine.[J].Spine J,2013,14(4):659-666.
[12] 李蒙,李磊,徐磊,等.PKP术后相邻椎体再骨折的相关因素分析[J].中国骨与关节损伤杂志,2017,32(7):692-694.
[13] Gradosovaabaaaa I.Protective effect of atorvastatin on bone tissue in orchidectomised male albino Wistar rats[J].Euro J Pharmacol,2012,679(1-3):144-150.
[14] 王慧,罗晓晋,武锋.辛伐他汀与Bio-Oss骨粉混合物对种植体周围缺损骨重建中破骨细胞的作用[J].中国药物与临床,2013,13(4):434-436.
[15] Chen XY,Li K,Alan R Light,et al.Simvastatin attenuates formalin-induced nociceptive behaviors by inhibiting microglial RhoA and p38 MAPK activation[J].J Pain,2013,14(11):1310-1319.
[16] Wang H,Sribastav SS,Ye F,et al.Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures:a meta-analysis of the literature[J].Pain Physician,2015,18(3):209-222.