唑来膦酸联合外科手术治疗骨质疏松性椎体压缩骨折的疗效及对骨代谢活力的影响
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摘要
目的探讨唑来膦酸联合外科手术治疗骨质疏松性椎体压缩骨折(OVCFs)的疗效及对骨代谢活力的影响。方法 2015年1月至2018年1月间在上海浦东新区浦南医院接受手术治疗的OVCFs患者98例,回顾术后治疗方案并分为:接受唑来膦酸治疗的唑来膦酸组52例、未经特殊处理的对照组46例。对比两组术前、术后1月、术后3月视觉模拟评分(VAS)及Oswestry功能障碍指数问卷(ODI)评分值的差异,以及上述时间点骨密度值及血清骨代谢指标[骨碱性磷酸酶(ALP)、Ⅰ型前胶原氨基末端肽(PⅠNP);骨吸收指标包括抗酒石酸酸性磷酸酶(TRACP)、β-胶原特殊序列(β-CTX)]含量的差异。结果术后1月、术后3月,两组患者的VAS、ODI分值均较术前下降,骨密度T值较术前增大,血清中骨形成指标ALP、PⅠNP的含量较术前增加而骨吸收指标TRACP、β-CTX的含量较术前降低,且唑来膦酸组上述时间点各个指标水平变化趋势大于对照组(P <0. 05)。结论 OVCFs患者接受外科手术及术后唑来膦酸治疗,可进一步提升治疗效果并增加骨密度、优化骨代谢进程。
Objective To investigate the effect of Reclast combined with Surgical on osteoporotic vertebral compression fractures( OVCFs) and their influence on bone metabolism activity. Methods 98 cases of OVCFs patients underwent surgical treatment in our hospital during January 2015 to January 2018 were chosen as research subject. Postoperative treatment plans were retrospectively reviewed and all patients were divided into: Migueta group( n = 52,Postoperative consolidation therapy) and Control group( n = 46,No special intervention after operation). The differences of visual analogue scale( VAS) and Oswestry dysfunction index( ODI) scores before operation,1 month after operation and3 months after operation were compared between two groups. Results 1 month and 3 months after operation,VAS and ODI scores of two groups were lower than those before operation,and bone mineral density T value was higher than that before operation. Serum contents of bone formation indexes such as ALP、PⅠNP were higher than those before operation,while contents of bone resorption indexes such as TRACP and β-CTX were lower than those before operation. The change trend of each index level at above time point were larger in Migueta group than those in Control group( P < 0. 05). Conclusion Surgical treatment and postoperative migueta therapy for OVCFs,can further enhance therapeutic effect,increase bone mineral density and optimize bone metabolism.
Objective To investigate the effect of Reclast combined with Surgical on osteoporotic vertebral compression fractures( OVCFs) and their influence on bone metabolism activity. Methods 98 cases of OVCFs patients underwent surgical treatment in our hospital during January 2015 to January 2018 were chosen as research subject. Postoperative treatment plans were retrospectively reviewed and all patients were divided into: Migueta group( n = 52,Postoperative consolidation therapy) and Control group( n = 46,No special intervention after operation). The differences of visual analogue scale( VAS) and Oswestry dysfunction index( ODI) scores before operation,1 month after operation and3 months after operation were compared between two groups. Results 1 month and 3 months after operation,VAS and ODI scores of two groups were lower than those before operation,and bone mineral density T value was higher than that before operation. Serum contents of bone formation indexes such as ALP、PⅠNP were higher than those before operation,while contents of bone resorption indexes such as TRACP and β-CTX were lower than those before operation. The change trend of each index level at above time point were larger in Migueta group than those in Control group( P < 0. 05). Conclusion Surgical treatment and postoperative migueta therapy for OVCFs,can further enhance therapeutic effect,increase bone mineral density and optimize bone metabolism.
引文
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[11]杨喜梅,薛苗,陈习超.不同风湿免疫疾病并发骨质疏松症应用密固达治疗的安全性分析[J].医药前沿,2018,9(10):51.
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[13] Iidaka T,Muraki S,Oka H,et al. Radiographic measurements of the hip joint and their associations with hip pain in Japanese men and women:the Research on Osteoarthritis/osteoporosis Against Disability(ROAD)study[J]. Osteoarthritis Cartilage,2017,25(12):2072-2079.
[14] Naylor KE,Bradburn M,Paggiosi MA,et al. Effects of discontinuing oral bisphosphonate treatments for postmenopausal osteoporosis on bone turnover markers and bone density[J]. Osteoporos Int,2018,29(6):1407-1417.
[15] Forciea MA,Mc Lean RM,Qaseem A. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women[J]. Ann Intern Med,2017,167(12):904.
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[17]魏建军,李东,颜世昌,等.强骨补肾活血方联合椎体成形术治疗绝经后骨质疏松性椎体压缩骨折疗效及对血清骨代谢标志物的影响[J].现代中西医结合杂志,2016,25(36):4012-4015.
[18] Zhao D,Wang J,Liu Y,et al. Expressions and clinical significance of serum bone Gla-protein,bone alkaline phosphatase and C-terminal telopeptide of type I collagen in bone metabolism of patients with osteoporosis[J]. Pak J Med Sci,2015,31(1):91-94.
[19] Mori Y,Kasai H,Ose A,et al. Modeling and simulation of bone mineral density in Japanese osteoporosis patients treated with zoledronic acid using tartrate-resistant acid phosphatase 5b,a bone resorption marker[J]. Osteoporos Int,2018,29(5):1155-1163.
[20]胡小刚,王红祥,王巧娥,等. t P1NP、OCN和β-CTX在骨质疏松性骨折和骨关节炎老年患者唑来膦酸治疗前后变化[J].临床和实验医学杂志,2018,17(12):1299-1302.
[21] Lee H,Kim MH,Choi YY,et al. Effects of Cynanchum wilfordii on osteoporosis with inhibition of bone resorption and induction of bone formation[J]. Mol Med Rep,2018,17(3):3758-3762.
[2] Zuo XH,Zhu XP,Bao HG,et al. Network meta-analysis of percutaneous vertebroplasty,percutaneous kyphoplasty,nerve block,and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures(OVCFs)in short-term and long-term effects[J]. Medicine(Baltimore),2018,97(29):e11544.
[3]吴祖同,张轶群,尹建文,等.过伸复位联合单侧入路椎体成形术治疗骨质疏松性胸腰椎体压缩骨折的疗效评价[J].疑难病杂志,2017,16(8):809-812.
[4] Gao C,Zong M,Wang WT,et al. Analysis of risk factors causing short-term cement leakages and long-term complications after percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Acta Radiol,2018,59(5):577-585.
[5]刘冬云,金彩环,苏镁婷,等.密固达治疗绝经后女性骨质疏松症的疗效及对生活质量的影响[J].中国妇幼保健,2018,33(3):621-623.
[6] Yang S,Chen C,Wang H,et al. A systematic review of unilateral versus bilateral percutaneous vertebroplasty/percutaneous kyphoplasty for osteoporotic vertebral compression fractures[J]. Acta Orthop Traumatol Turc,2017,51(4):290-297.
[7] Liu T,Li Z,Su Q,et al. Cement leakage in osteoporotic vertebral compression fractures with cortical defect using high-viscosity bone cement during unilateral percutaneous kyphoplasty surgery[J]. Medicine(Baltimore),2017,96(25):e7216.
[8] Lee CY,Suzuki JB. Medication-related osteonecrosis of the jaws from once per year intravenous zoledronic acid(Reclast):report of 4 cases[J]. Implant Dent,2015,24(2):227-231.
[9] Katz J,Ordoveza PA. Bisphosphonate-related osteonecrosis of the jaw(BRONJ)associated with a once-yearly IV infusion of zoledronic acid(Reclast)5 mg:two cases and review of the literature[J]. Quintessence Int,2014,45(8):685-690.
[10]姜贵军.密固达治疗糖尿病性骨质疏松的临床分析[J].中西医结合心血管病电子杂志,2016,4(18):78.
[11]杨喜梅,薛苗,陈习超.不同风湿免疫疾病并发骨质疏松症应用密固达治疗的安全性分析[J].医药前沿,2018,9(10):51.
[12] González-Chica DA,Vanlint S,Hoon E,et al. Epidemiology of arthritis,chronic back pain,gout,osteoporosis,spondyloarthropathies and rheumatoid arthritis among 1. 5 million patients in Australian general practice:NPS MedicineWise MedicineInsight dataset[J]. BMC Musculoskelet Disord,2018,19(1):20.
[13] Iidaka T,Muraki S,Oka H,et al. Radiographic measurements of the hip joint and their associations with hip pain in Japanese men and women:the Research on Osteoarthritis/osteoporosis Against Disability(ROAD)study[J]. Osteoarthritis Cartilage,2017,25(12):2072-2079.
[14] Naylor KE,Bradburn M,Paggiosi MA,et al. Effects of discontinuing oral bisphosphonate treatments for postmenopausal osteoporosis on bone turnover markers and bone density[J]. Osteoporos Int,2018,29(6):1407-1417.
[15] Forciea MA,Mc Lean RM,Qaseem A. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women[J]. Ann Intern Med,2017,167(12):904.
[16] Reginster JY,Rizzoli R,Kanis JA,et al. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women[J]. Ann Intern Med,2017,167(12):902-903.
[17]魏建军,李东,颜世昌,等.强骨补肾活血方联合椎体成形术治疗绝经后骨质疏松性椎体压缩骨折疗效及对血清骨代谢标志物的影响[J].现代中西医结合杂志,2016,25(36):4012-4015.
[18] Zhao D,Wang J,Liu Y,et al. Expressions and clinical significance of serum bone Gla-protein,bone alkaline phosphatase and C-terminal telopeptide of type I collagen in bone metabolism of patients with osteoporosis[J]. Pak J Med Sci,2015,31(1):91-94.
[19] Mori Y,Kasai H,Ose A,et al. Modeling and simulation of bone mineral density in Japanese osteoporosis patients treated with zoledronic acid using tartrate-resistant acid phosphatase 5b,a bone resorption marker[J]. Osteoporos Int,2018,29(5):1155-1163.
[20]胡小刚,王红祥,王巧娥,等. t P1NP、OCN和β-CTX在骨质疏松性骨折和骨关节炎老年患者唑来膦酸治疗前后变化[J].临床和实验医学杂志,2018,17(12):1299-1302.
[21] Lee H,Kim MH,Choi YY,et al. Effects of Cynanchum wilfordii on osteoporosis with inhibition of bone resorption and induction of bone formation[J]. Mol Med Rep,2018,17(3):3758-3762.