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| 唑来膦酸和特立帕肽对预防椎体成形术后再发骨折的疗效比较 |
| Comparison of the efficacy between zolledronic acid and triptapeptide in preventing secondary fracture after vertebroplasty |
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| DOI：10.3969/j.issn.1006.7108.2019.07.024 |
| 中文关键词: 唑来膦酸 特立帕肽 骨质疏松性椎体压缩骨折 椎体成形 再发骨折 |
| 英文关键词:zoledronic acid teriparatide osteoporotic vertebral compression fracture vertebroplasty secondary fracture |
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| 中文摘要: |
| 目的 比较唑来膦酸和特立帕肽对椎体成形术（percutaneous vertebroplasty, PVP）治疗骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture, OVCF）术后再发骨折的影响。方法 收集2016年6月到2017年6月在我院骨科接受PVP治疗且符合条件的女性患者共60例，其中40人在术后接受了唑来膦酸治疗（A组），20人在术后接受了特立帕肽治疗（B组），两组患者均给予维生素D和钙剂基础治疗。术前、术后6月、末次随访行骨代谢指标血清I型前胶原N末端前肽（PINP）和Ⅰ型胶原羧基端 β 降解产物（β-CTX） 检测及骨密度检测，同时记录随访期间再发骨折不良事件。结果 A组患者术后6个月PINP和β-CTX值较术前显著下降（P﹤0.05），而末次随访时PINP较术后6月未见明显改变，β-CTX则进一步降低，差异具有统计学意义（P﹤0.05）；A组患者术后6月和末次随访骨密度检测与术前相比虽有增长，但差异未见统计学意义（P﹥0.05）。B组患者术后6个月PINP和β-CTX值较术前显著上升，且其上升趋势可以维持到末次随访，与术前比较差异具有统计学意义（P﹤0.05）；B组患者术后6个月骨密度较术前明显提高（P﹤0.05），尽管在末次随访时骨密度略有降低，但仍较术前明显升高（P﹤0.05）。A组再发骨折率（10/40，25%）明显高于B组（1/20，5%），相关性分析显示再发骨折与骨密度（r=0.028，P﹤0.05）和PINP检测值（r=–0.013，P﹤0.05）密切相关。结论 特立帕肽较唑来膦酸能更好预防椎体成形术后再发骨折，其潜在机制与更有效改善骨代谢，提高骨密度有关。 |
| 英文摘要: |
| Objective To compare the efficacy between zolledronic acid and triptapeptide in preventing secondary fractures after percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fracture (OVCF). Methods From June 2016 to June 2017, 60 female patients receiving PVP treatment in our hospital were collected. Among them, 40 patients received zolledronic acid (Group A) and 20 patients received triptapeptide (Group B) after operation, respectively. Patients in both groups received basic treatment with vitamin D and calcium. The serum PINP and β-CTX and bone mineral density (BMD) were detected preoperatively, 6 months postoperatively, and at the last follow-up. Simultaneously, adverse events of secondary fractures after PVP were recorded during follow-up. Results The values of PINP and β-CTX decreased significantly at 6-month post operation in Group A (P<0.05). Moreover, at the final follow-up, the value of PINP did not change significantly compared with that at the 6-month post operation (P>0.05), but the value of β-CTX further decreased, with statistic difference (P<0.05). The BMD of patients in Group A slightly increased at 6-month post operation and the final follow-up, but without statistic difference compared with that preoperation. The values of PINP and β-CTX increased significantly at the 6-month post operation than preoperatively in Group B (P<0.05). Furthermore, the uptrend of these two indexes continued to the final follow-up. The BMD in Group B also improved significantly at 6-month post operation (P<0.05). Although the BMD slightly decreased at the final follow-up, which was still obviously higher than that preoperatively (P<0.05). The rate of secondary fractures was 25% (10/40) in Group A, which was significantly higher than that in Group B (1/20, 5%). The further correlation analysis showed that the re-collapse rate was closely correlated with BMD (r=0.028, P<0.05) and PINP (r=-0.013, P<0.05). Conclusion Triptapeptide has better preventive effect on secondary fractures after PVP treatment compared with zolledronic acid. The potential mechanism is related to more effective in the improvement of bone metabolism and BMD of triptapeptide. |
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