文章摘要
何学军,金鑫,胡全文,范朝铭,王劲乐,孙勇伟,陈轲.抗骨质疏松药物对急性骨质疏松性脊柱骨折后放射学特征和临床结果的影响.骨科,2020,11(6):529-534
抗骨质疏松药物对急性骨质疏松性脊柱骨折后放射学特征和临床结果的影响
Effect of anti-osteoporosis drugs on radiological features and clinical outcomes in acute osteoporotic spinal fracture
投稿时间:2019-11-27  
DOI:10.3969/j.issn.1674-8573.2020.06.012
中文关键词: 骨质疏松性脊柱骨折  甲状旁腺激素  骨吸收抑制剂
英文关键词: Osteoporotic spinal fracture  Parathyroid hormone  Anti-resorptive
基金项目:
作者单位E-mail
何学军 咸阳市第一人民医院骨科陕西咸阳 712000  
金鑫 咸阳市第一人民医院骨科陕西咸阳 712000  
胡全文 咸阳市第一人民医院骨科陕西咸阳 712000  
范朝铭 咸阳市第一人民医院骨科陕西咸阳 712000  
王劲乐 咸阳市第一人民医院骨科陕西咸阳 712000  
孙勇伟 咸阳市第一人民医院骨科陕西咸阳 712000  
陈轲 咸阳市第一人民医院骨科陕西咸阳 712000 chenk8888888888@163.com 
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中文摘要:
      目的 探讨不同抗骨质疏松药物治疗对急性骨质疏松性脊柱骨折(osteoporotic spinal fracture, OSF)后放射学特征和临床结果的影响。方法 前瞻性纳入120例拟接受保守治疗的老年OSF病人,根据随机数字表将病人分为对照组(40例)、骨吸收抑制剂组(40例)和甲状旁腺激素(parathyroid hormone, PTH)组(40例),分别在保守治疗的基础上接受安慰剂、双膦酸盐、特立帕肽治疗3个月。比较三组病人治疗前后的数字分级法(numerical rating scale, NRS)疼痛评分、Oswestry功能障碍指数(Oswestry disability index, ODI)、骨折椎体高度丢失比、后凸角和椎骨隐裂(intravertebral cleft, IVC)发生情况。结果 经过3个月治疗,PTH组的NRS评分、ODI均明显低于对照组和骨吸收抑制剂组,骨吸收抑制剂组的上述指标也显著低于对照组,差异均有统计学意义(P均<0.05)。PTH组和骨吸收抑制剂组的椎体高度丢失比均低于对照组,差异均有统计学意义(P均<0.05);但骨吸收抑制剂组和PTH组比较,差异无统计学意义(P>0.05)。三组病人治疗后的后凸角比较,差异无统计学意义(P>0.05)。PTH组的IVC发生率显著低于对照组(P<0.05),但骨吸收抑制剂组和对照组比较,差异无统计学意义(P>0.05)。单因素及多因素Logistic回归分析显示MRI Ⅱ型[OR=3.531,95% CI(2.300,5.628),P<0.001]是导致骨折愈合不良的独立危险因素,PTH[OR=0.826,95% CI(0.703,0.966),P=0.018]和骨吸收抑制剂[OR=0.853,95% CI(0.768,0.962),P=0.006]是预防骨折愈合不良的独立保护性因素。结论 PTH类合成代谢药物可以有效促进骨折愈合、减少椎体塌陷,并显著减轻病人疼痛和促进脊柱功能恢复。
英文摘要:
      Objective To investigate the effects of different anti-osteoporosis drugs on radiological features and clinical outcomes in acute osteoporotic spinal fracture (OSF). Methods Prospectively included 120 elderly patients with OSF who underwent conservative treatment were divided into control group (40 cases), bisphosphonate group (40 cases) and parathyroid hormone (PTH) group (40 cases) according to random number table, which were treated with placebo, bisphosphonate and teriparatide respectively for 3 months on a conservative basis. The numerical rating scale (NRS), Oswestry disability index (ODI), intravertebral cleft (IVC), fracture vertebral height loss ratio, and kyphotic angle after treatment were compared among the three groups. Results After 3 months of treatment, the NRS score and ODI score in the PTH group were significantly lower than those in the control group and the bisphosphonate group, and the NRS score and ODI in the bisphosphonate group were also significantly lower than in the control group (P<0.05). The vertebral height loss ratio in the PTH group and the bisphosphonate group was lower than that in the control group (P<0.05), but there was no significant difference between the bisphosphonate group and the PTH group (P>0.05). There was no significant difference in kyphotic angle among the three groups (P>0.05). The incidence of IVC in the PTH group was significantly lower than that in the control group (P<0.05), but there was no significant difference between the bisphosphonate group and the control group (P>0.05). Univariate and multivariate logistic regression analysis showed that PTH [OR=0.826, 95% CI (0.703, 0.966), P=0.018] and bisphosphonate [OR=0.853, 95% CI (0.768, 0.962), P=0.006] were independent protective factors for preventing poor fracture healing, while the MRI Ⅱ type [OR=3.531, 95% CI (2.300, 5.628), P<0.001] was the risk factor of it. Conclusion PTH anabolic drugs can effectively promote fracture healing, reduce vertebral collapse, significantly reduce pain, and promote spinal function recovery.
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