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| 基于快速康复外科理念系统治疗骨质疏松性椎体压缩骨折的临床疗效评估 |
| Evaluation of clinical efficacy of comprehensive treatment based on enhanced recovery after surgery for osteoporotic vertebral compression fractures |
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| DOI：10.3969/j.issn.1006.7108.2019.09.019 |
| 中文关键词: 骨质疏松 椎体骨折 骨代谢 快速康复外科 |
| 英文关键词:osteoporosis vertebral fracture bone metabolism enhanced recovery after surgery |
| 基金项目:上海市虹口区卫生和计划生育委员会课题资助项目（虹卫1802-19）；上海市虹口区临床医学优秀青年人才培养计划资助项目（HKYQ2018-13） |
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| 中文摘要: |
| 目的 评估基于快速康复外科理念系统治疗骨质疏松性椎体压缩骨折的临床疗效。方法 回顾2015年1月至2017年6月我科基于快速康复外科（ERAS）理念因骨质疏松性椎体压缩骨折（OVCFs）行椎体后凸成形术（PKP），且随访期间系统规律治疗原发病骨质疏松患者125例。收集术前及术后1周疼痛模拟VAS(visual analog scale)评分和伤残ODI(oswestry disability index)指数，记录术前及术后12个月骨密度（bone mass density，BMD）指标及血清I型胶原氨基端前肽( procollagen type1 amino-terminal propeptide, P1NP) 、β 胶原降解产物( beta collagen degradation products, β-CTX)及25-羟基维生素D（25(OH)D）等骨代谢指标进行比较分析。结果 系统治疗1周后，VAS评分由入院时(6.35?1.0)分降至(1.34?0.9)分（P?0.001），ODI由入院时（44.8?5.3）%降至（16.8?3.5）%（P?0.001）。术后12个月，BMD指标T值由术前（–2.7?0.3）SD增至（–2.5?0.2）SD（P?0.001），骨代谢指标PINP由术前（57.0?17.7）ng/mL增至（73.3?19.7）ng/mL（P?0.001），?-CTX由术前（502.3?221.9）pg/mL降至（220.0?123.6）pg/mL（P?0.001），25(OH)D由术前（35.3?2.2）nmol/L增至（36.2?7.7）nmol/L（P=0.202）。结论 ①PKP手术可有效缓解OVCFs患者腰背痛，改善患者双下肢功能状态，提高其生活质量；②基于ERAS理念系统治疗OVCFs，可通过抑制骨吸收、促进新骨形成来提高骨密度、改善骨质，对预防骨质疏松再骨折具有重要意义。 |
| 英文摘要: |
| Objectives To explore the clinical efficacy of comprehensive treatment based on enhanced recovery after surgery (ERAS) for osteoporotic vertebral compression fractures. Methods A total of 125 patients with osteoporotic vertebral compression fractures (OVCFs) were retrospectively studied in our department from January 2015 to June 2017. They were treated with percutaneous kyphoplasty (PKP) based on enhanced recovery after surgery (ERAS) theory and systemic comprehensive treatment of osteoporosis was performed during follow-up. Visual analog scale (VAS) score and Oswestry disability index (ODI) were collected before and 1 week after PKP. Bone mineral density (BMD), procollagen type1 amino-terminal propeptide (PINP), beta collagen degradation products (β-CTX), and 25(OH)D were recorded before and 1 year after PKP, and were compared and analyzed. Results One week after comprehensive treatment, VAS decreased from 6.35?1.0 to 1.34?0.9 (P=0.000), ODI decreased from (44.8?5.3) % to (16.8?3.5) % (P=0.000). After 12 months of the operation, T score of BMD increased from (–2.7?0.3) SD to (–2.5?0.2) SD (P=0.000), PINP increased from (57.0?17.7) ng/ml to (73.3?19.7) ng/ml (P=0.000), ?-CTX decreased from (502.3?221.9) pg/ml to (220.0?123.6) pg/ml (P=0.000), and 25(OH)D increased from (35.3?2.2) nmol/L to (36.2?7.7) nmol/L (P=0.202). Conclusions ①Low back pain is relieved, function of limbs and quality of life are improved in patients with OVCFs after PKP; ②After systemic comprehensive treatment based on ERAS, BMD is increased and bone quality is improved by inhibiting bone resorption and promoting new bone formation, thereby preventing the re-fracture. |
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