中国骨质疏松杂志

唑来膦酸在骨质疏松合并脊柱结核综合治疗中的疗效观察

Efficacy of zoledronic acid in the comprehensive treatment of osteoporosis associated with spinal tuberculosis

DOI：10.3969/j.issn.1006-7108.2015.02.021

英文关键词:Zoledronic acid Osteoporosis Spinal tuberculosis

基金项目:全军医学科技青年培育项目（4241287K）

作者	单位
刘志1李大伟2 王亮2 马远征2*	1．河北北方学院，河北张家口 075000 2．解放军第309医院，北京 100091

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中文摘要:

目的探讨唑来膦酸在骨质疏松合并脊柱结核综合治疗中的疗效。方法将我科2010年~2013年收治的40例脊柱结核伴骨质疏松患者分为A、B两组， A组20 例，为治疗组，平均年龄67.4±5.32岁，术后静脉滴注唑来膦酸5mg，并口服钙尔奇D片2片/天，持续12个月；B组20例，为对照组，平均年龄65.3±6.54岁。给予口服钙尔奇D片2片/天以及阿尔法D3 0.25 μg/d，持续12个月。观察治疗前后两组患者股骨颈（Neck）骨密度、血沉（ESR）、血清β-Ⅰ型胶原交联羧基末端肽（β-CTX）、骨特异性碱性磷酸酶（BALP）以及影像学的变化情况。结果所有患者均顺利完成手术治疗，随访时间1~2.7年，平均1.8年。A、B两组术前股骨颈（Neck）骨密度、ESR、β-CTX 、BALP 均无明显差异。治疗后A组股骨颈（Neck）骨密度显著高于B组（P＜0.05），A组患者治疗后β-CTX较术前下降明显（P＜0.05），BALP与术前比较无统计学差异（P＞0.05）。B组患者β-CTX 、BALP与治疗前比较无明显差异（P＞0.05），治疗后A组β-CTX较B组下降明显，有统计学意义（P＜0.05），BALP组间比较无明显差异（P＞0.05）。A、B组治疗后ESR均较术前缓解明显（P＜0.05），组间比较无明显差异（P＞0.05）。术后影像学资料提示随访患者均获得Ⅰ级植骨融合，植骨融合率100%，末次随访时未发生断钉断棒情况，B组3例患者内固定松动，余患者内固定位置良好，无明显内固定移位，组间比较无明显差异（P＞0.05）。结论唑来膦酸在骨质疏松合并脊柱结核的综合治疗中可取得良好的效果。

英文摘要:

Objective To investigate the efficacy of zoledronic acid in the comprehensive treatment of osteoporosis associated with spinal tuberculosis. Methods Forty cases of spinal tuberculosis in our department from 2010 to 2013 were divided into group A and B. Twenty patients in group A, with mean age of 67.4±5.32 years old, received intravenous zoledronic acid 5mg, oral Caltrate D 2 tablets/day for 12 months after the operation. Twenty patients in group B, as the control group with a mean age of 65.3±6.54 years old, received Caltrate D 2 tablets /day and Alpha D3 0.25 ug/d for 12 months. The changes of BMD, erythrocyte sedimentation rate (ESR), serum β-I collagen cross-linked carboxy-terminal peptide (β-CTX), bone-specific alkaline phosphatase (BALP), and imaging data were observed in patients of the two groups before and after the treatment. Results All the patients were successfully operated. They were followed up for 1-2.7 years, with an average of 1.8 years. BMD of the femoral neck, ESR, β-CTX, and BALP were not different between the two groups before the surgery. After the treatment, BMD of the femoral neck in group A was significantly higher than that in group B (P<0.05). ESR decreased significantly in group A after the surgery (P<0.05). BALP was constant (P > 0.05). β-CTX and BALP were not different in group B after the treatment compared to those before the treatment (P>0.05). β-CTX decreased significantly in group A compared to that in group B (P>0.05). BALP was not different between the groups (P>0.05). ESR was relieved in both groups after the treatment, without difference between the groups (P>0.05). Imaging data suggested that all the patients followed obtained grade I fusion, with a fusion rate of 100%. No broken nails or broken rods occurred at the last follow-up. Loosening of the nail occurred in 3 cases in group B. Other nails were fixed well in position without shifting. There was no significant difference between the two groups (P>0.05). Conclusion Zoledronic acid has good efficacy in the comprehensive treatment of spinal tuberculosis associated with osteoporosis.

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