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| 腰椎退行性疾病伴骨质疏松患者行腰椎融合术后应用唑来膦酸的临床疗效观察 |
| Efficacy of zoledronic acid on lumbar fusion patients with lumbar degenerative disease associated with osteoporosis |
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| DOI：10.3969/j.issn.1006.7108.2015.04.011 |
| 中文关键词: 腰椎退行性 骨质疏松 腰椎融合 唑来膦酸 |
| 英文关键词:Lumbar degenerative disease Osteoporosis Lumbar fusion Zoledronic acid |
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| 中文摘要: |
| 目的 观察腰椎退行性疾病伴骨质疏松患者行腰椎融合术后应用唑来膦酸的临床疗效。方法选取2013年3月至2013年10月在解放军第309医院接受腰椎融合手术治疗，术前明确诊断为腰椎退行性疾病，同时诊断为骨质疏松症患者，将其分为研究组和对照组，两组术前性别比例、年龄、ODI评分、BMI指数均无统计学差异（P >0. 05 )，研究组术后第5天应用唑来膦酸进行干预，临床观察指标:术前、术后3、6、12个月时的Oswestry功能障碍指数评分、骨转换生化标志物CTX和PINP、骨密度和影像学变化。结果 获得完整随访病例资料26例，研究组和对照组各13例，两组术后ODI评分较术前均显著性下降 (P <0. 05)，其中术后3个月时ODI评分显著降低，术后6个月时进入平台期，术后12个月时有所回升，但研究组ODI评分在12个月时低于对照组，有统计学差异(P <0. 05)。研究组骨转换标志物PINP和CTX在术后3、6、12个月呈下降趋势，其中CTX下降幅度较大，对照组无显著变化。术后12个月时，研究组所测量的3个部位骨密度均有所改善，其中股骨颈改善显著 (P <0.05)。26例患者均获得良好融合，随访中出现椎体压缩性骨折研究组2例，对照组为6例，椎间融合器下沉研究组1 例，对照组4例。结论 腰椎退行性疾病伴骨质疏松患者在行腰椎融合术后应用唑来膦酸具有一定的辅助治疗作用，对植骨融合无不利影响。 |
| 英文摘要: |
| Objective To observe the efficacy of zoledronic acid on patients with lumbar degenerative disease with osteoporosis after lumbar interbody fusion. Methods Patients were selected who accepted lumbar fusion operation in our hospital from March 2013 to October 2013，with preoperative diagnosis of lumbar degenerative disease and osteoporosis. They were divided into study group and control group. There was no statistical difference between the two groups before the operation in terms of sex ratio，age，ODI score，and BMI index (P >0.05). Patients in study group received zoledronic acid from the fifth day after the operation. Oswestry disability index，bone biochemical markers CTX and PINP，bone mineral density，and the imaging change were observed before the surgery and 3，6，and 12 months after the surgery. Results Complete follow-up data of 26 cases，13 cases each from the study group and the control group，were obtained. ODI score decreased significantly in both groups after the operation (P < 0.05). The decrease was most significant on 3 months after the operation，and then it was on a platform on 6 months，and rebounded from 12 months. ODI score was lower in the study group than in control group on 12 months，with significant difference (P <0. 05). The bone turnover markers PINP and CTX decreased in 3，6，and 12 months after the operation. The decrease of CTX was the most obviously. No significant change was found in control group. BMD of 3 parts improved in study group after 12 months of the operation，which was most significantly in the femoral neck (P < 0. 05). All the 26 patients obtain good fusion. Vertebral compression fracture occurred in 2 cases in study group and 6 cases in control group. The intervertebral fusion cage subsidence occurred in 1 case in study group and 4 cases in control group. Conclusion Zoledronic acid has certain auxiliary therapeutic effect on lumbar degenerative disease with osteoporosis after lumbar spinal fusion. and has no adverse effect on bone fusion. |
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