【摘要】：目的觀察經(jīng)皮球囊擴(kuò)張椎體成形術(shù)(PKP)聯(lián)合靜滴唑來膦酸治療老年骨質(zhì)疏松性椎體壓縮性骨折(OVCF)的療效及超前預(yù)防性使用非甾體消炎鎮(zhèn)痛藥西樂葆對(duì)靜滴唑來膦酸后急性期不良反應(yīng)(APR)的預(yù)防治療效果。方法回顧性分析武漢市普愛醫(yī)院于2010年1月至2013年12月采用單側(cè)PKP術(shù)治療單節(jié)段老年骨質(zhì)疏松性椎體壓縮性骨折并獲得1年以上隨訪的患者116例,根據(jù)患者術(shù)后是否應(yīng)用唑來膦酸(密固達(dá))分為A(試驗(yàn)組,67例)、B(對(duì)照組,49例)兩組,其中A組PKP術(shù)后3d使用唑來膦酸,根據(jù)是否在靜滴唑來膦酸前3d給予西樂葆口服,又將A組分為C(非西樂葆組,30例)、D(西樂葆組,37例)兩組。分別測(cè)量A組和B組患者術(shù)前及術(shù)后1年的骨密度,對(duì)PKP術(shù)后鄰近椎體骨折(AVF)的發(fā)生率進(jìn)行統(tǒng)計(jì),術(shù)前、術(shù)后隨訪時(shí)采用疼痛視覺模擬評(píng)分(VAS)評(píng)估疼痛程度,采用Oswestry評(píng)分評(píng)估活動(dòng)能力,并對(duì)骨折椎體高度及Cobb角變化進(jìn)行分析,評(píng)估PKP聯(lián)合唑來膦酸治療老年骨質(zhì)疏松性椎體壓縮性骨折的療效。同時(shí)觀察C組和D組APR的發(fā)生率,發(fā)熱程度及肌肉骨骼疼痛程度的差異,評(píng)估超前預(yù)防性使用西樂葆對(duì)靜滴唑來膦酸后APR的預(yù)防效果。結(jié)果治療1年后A組患者股骨近端骨密度明顯提高,治療后1年內(nèi)無新發(fā)椎體骨折的發(fā)生,B組術(shù)后1年期間有脊柱骨性疼痛加重趨勢(shì),隨訪期間新發(fā)椎體骨折10例,其中新發(fā)AVF 6例。兩組患者術(shù)后傷椎椎體高度、Cobb角、VAS評(píng)分和Oswestry評(píng)分均較術(shù)前明顯改善,差異有統(tǒng)計(jì)學(xué)意義(均P0.05),但術(shù)后兩組間比較無顯著性差異。C組和D組APR發(fā)生率、發(fā)熱及肌肉骨骼疼痛程度差異均有統(tǒng)計(jì)學(xué)意義(均P0.01)。兩組患者均無其它不良反應(yīng)發(fā)生。結(jié)論唑來膦酸聯(lián)合PKP技術(shù)治療老年骨質(zhì)疏松性骨折效果顯著,可明顯提高骨質(zhì)疏松性患者骨密度,預(yù)防骨量持續(xù)丟失,提高患者生活質(zhì)量,并有效減輕全身及脊柱骨性疼痛癥狀,預(yù)防再次骨折的發(fā)生,可作為骨質(zhì)疏松性骨折PKP術(shù)后一種有效的輔助治療措施。超前預(yù)防性使用非甾體消炎鎮(zhèn)痛藥西樂葆可大大降低靜滴唑來膦酸后急性期不良反應(yīng)的發(fā)生率及發(fā)熱和肌肉骨骼疼痛的程度。
[Abstract]:Objective to observe the efficacy of percutaneous balloon dilatation vertebroplasty (PKP) combined with intravenous dazoledronic acid in the treatment of senile osteoporotic vertebral compression fracture (OVCF) and the prophylactic use of nonsteroidal antiinflammatory analgesics (NSAID) Celebrex in the treatment of intravenous zoledronic acid. Prevention and treatment effect of (APR) in post acute adverse reaction. Methods from January 2010 to December 2013, 116 patients with unilateral osteoporotic vertebral compression fractures were treated with unilateral PKP and followed up for more than one year. According to whether the patients were treated with zoledronic acid or not, they were divided into two groups: group A (67 cases of experimental group) and group B (49 cases of control group). Group A received zoledronic acid 3 days after operation, according to whether Celebrex was given orally 3 days before intravenous didzoledronic acid. Group A was divided into two groups: C (30 cases of non-Celebrex group) and D group (37 cases of Celebrex group). Bone mineral density (BMD) of patients in group A and group B were measured before and 1 year after operation. The incidence of (AVF) in patients with adjacent vertebral body fractures after PKP was counted. The pain degree was evaluated by visual analogue score (VAS) during follow-up before and after operation. The activity ability was evaluated by Oswestry score and the changes of vertebral height and Cobb angle were analyzed to evaluate the efficacy of PKP combined with zoledronic acid in the treatment of senile osteoporotic vertebral compression fracture. At the same time, the incidence of APR, the degree of fever and the degree of musculoskeletal pain were observed between group C and group D, and the preventive effect of prophylaxis of Celebrex on APR after intravenous tiazoledronic acid was evaluated. Results the bone mineral density of proximal femur increased significantly in group A one year after treatment, and there was no new vertebral body fracture in group B during one year after treatment. There was a tendency of spinal bone pain in group B, and 10 cases of new vertebral body fracture occurred during follow-up. Among them, 6 cases were newly developed AVF. The VAS score and Oswestry score of the injured vertebral body height were significantly improved in the two groups (P0.05), but there was no significant difference between the two groups after operation. The incidence of APR in group C and group D was not significantly different between the two groups. There were significant differences in fever and musculoskeletal pain (P 0.01). No other adverse reactions occurred in both groups. Conclusion Zoledronic acid combined with PKP is effective in the treatment of osteoporotic fracture in elderly patients. It can significantly increase bone density, prevent bone loss and improve quality of life in patients with osteoporosis. It can effectively relieve the symptoms of systemic and spinal bone pain and prevent the occurrence of refracture. It can be used as an effective adjuvant treatment for osteoporotic fracture after PKP. Prophylaxis of nonsteroidal anti-inflammatory and analgesic drug Celebrex can significantly reduce the incidence of adverse reactions and the degree of fever and musculoskeletal pain after intravenous drip of azoledronic acid.
【作者單位】： 華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬武漢市普愛醫(yī)院脊柱外科;
【基金】：衛(wèi)生部衛(wèi)生行業(yè)專項(xiàng)項(xiàng)目(No.W2014ZT294)
【分類號(hào)】：R580;R687.3

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王利;楊毅;張學(xué)軍;鮮楊;吳冀川;楊艷;包明晶;張磊;朱顯軍;曹旭;劉麗梅;李蓬秋;;唑來膦酸治療原發(fā)性骨質(zhì)疏松癥50例的疼痛緩解及安全性觀察[J];中國骨質(zhì)疏松雜志;2011年12期

2 黃鳳蘭;楊躍林;;唑來膦酸治療原發(fā)性骨質(zhì)疏松癥臨床療效研究[J];醫(yī)學(xué)理論與實(shí)踐;2014年12期

3 湯涌;陳丹;張靜;;唑來膦酸治療糖尿病性骨質(zhì)疏松68例[J];中國藥業(yè);2014年15期

4 郝杰;胡偵明;張曉軍;江維;沈皆亮;;唑來膦酸治療老年原發(fā)性骨質(zhì)疏松癥的臨床安全性觀察[J];中國骨質(zhì)疏松雜志;2013年01期

5 黎華;;唑來膦酸治療絕經(jīng)后婦女骨質(zhì)疏松癥的臨床研究[J];中國醫(yī)藥指南;2011年14期

6 趙虹云;左順英;胡軍;裴春玲;劉瀟蔚;;唑來膦酸治療原發(fā)性骨質(zhì)疏松癥的臨床觀察[J];中國實(shí)用醫(yī)藥;2012年01期

7 袁元杏;李青;張非;趙成毅;梅治;張愛明;姚海燕;;唑來膦酸鈉應(yīng)用近期安全性觀察[J];中國骨質(zhì)疏松雜志;2012年10期

8 蔡思林;;唑來膦酸治療原發(fā)性骨質(zhì)疏松癥療效觀察[J];中國現(xiàn)代藥物應(yīng)用;2014年06期

9 徐利民;周賢剛;;唑來膦酸治療惡性腫瘤放(化)療后骨質(zhì)疏松的療效觀察[J];實(shí)用臨床醫(yī)學(xué);2008年10期

10 郭三忠;趙斌;謝振航;;唑來膦酸治療原發(fā)性骨質(zhì)疏松癥的療效觀察[J];中國骨與關(guān)節(jié)損傷雜志;2012年11期

相關(guān)會(huì)議論文 前5條

1 李春海;;唑來膦酸治療絕經(jīng)后骨質(zhì)疏松癥療效及安全性評(píng)價(jià)[A];中華醫(yī)學(xué)會(huì)第六次全國骨質(zhì)疏松和骨礦鹽疾病學(xué)術(shù)會(huì)議暨中華醫(yī)學(xué)會(huì)骨質(zhì)疏松和骨礦鹽疾病分會(huì)成立十周年論文匯編[C];2011年

2 趙鐘文;郭燕芬;吳方真;吳寬裕;陳煜宇;朱敏;;唑來膦酸注射液(密固達(dá))治療繼發(fā)性骨質(zhì)疏松癥致下肢靜脈血栓形成1例[A];全國第十一屆中西醫(yī)結(jié)合風(fēng)濕病學(xué)術(shù)會(huì)議論文匯編[C];2013年

3 宗軍;馬永東;吳曉東;張濤;胡英江;何飛;;預(yù)防使用雙氯芬酸鈉降低應(yīng)用唑來膦酸的原發(fā)性骨質(zhì)疏松癥患者不良反應(yīng)的效果觀察[A];中華醫(yī)學(xué)會(huì)第五次中青年骨質(zhì)疏松和骨礦鹽疾病學(xué)術(shù)會(huì)議論文集[C];2013年

4 潘曉潔;斯徐偉;;唑來膦酸對(duì)骨質(zhì)疏松性骨折愈合影響的研究進(jìn)展[A];2013年浙江省醫(yī)學(xué)會(huì)老年醫(yī)學(xué)學(xué)術(shù)年會(huì)暨國家級(jí)繼教項(xiàng)目老年人優(yōu)化健康管理研討班論文匯編[C];2013年

5 潘曉潔;斯徐偉;;唑來膦酸對(duì)骨質(zhì)疏松性骨折愈合影響的研究進(jìn)展[A];2013年浙江省醫(yī)學(xué)會(huì)骨質(zhì)疏松與骨礦鹽疾病分會(huì)學(xué)術(shù)年會(huì)暨國家級(jí)骨質(zhì)疏松癥和骨質(zhì)疏松性骨折診治進(jìn)展專題研討會(huì)論文匯編[C];2013年

相關(guān)重要報(bào)紙文章 前2條

1 劉敏邋譯;唑來膦酸一年用一次即可防治骨質(zhì)疏松[N];中國醫(yī)藥報(bào);2008年

2 阿勝 編譯;降鈣降過了頭？[N];醫(yī)藥經(jīng)濟(jì)報(bào);2004年

相關(guān)博士學(xué)位論文 前1條

1 崔敏;唑來膦酸對(duì)骨質(zhì)疏松患者外周血淋巴細(xì)胞亞群的影響及其意義[D];山東大學(xué);2017年

相關(guān)碩士學(xué)位論文 前10條

1 郝旭光;唑來膦酸聯(lián)合rhBMP-2局部注射對(duì)兔骨質(zhì)疏松模型髖部骨強(qiáng)度的作用研究[D];第四軍醫(yī)大學(xué);2015年

2 徐闊;金天格膠囊聯(lián)合唑來膦酸治療新疆維吾爾族骨質(zhì)疏松患者的療效[D];新疆醫(yī)科大學(xué);2015年

3 文靜;唑來膦酸對(duì)骨質(zhì)疏松患者骨形態(tài)發(fā)生蛋白-9和胰島β細(xì)胞功能影響的臨床研究[D];山西醫(yī)科大學(xué);2016年

4 楊晶;唑來膦酸對(duì)骨質(zhì)疏松患者血清chemerin和脂代謝影響的臨床研究[D];山西醫(yī)科大學(xué);2016年

5 王東洲;唑來膦酸急性期不良反應(yīng)在保守與手術(shù)治療骨質(zhì)疏松骨折的對(duì)比分析[D];吉林大學(xué);2016年

6 林琪佶;唑來膦酸治療絕經(jīng)后骨質(zhì)疏松癥的療效分析[D];浙江大學(xué);2016年

7 陰露佳;NFATc1過表達(dá)對(duì)唑來膦酸誘發(fā)的破骨細(xì)胞抑制的挽救效應(yīng)[D];華北理工大學(xué);2016年

8 郭慧;唑來膦酸對(duì)OPG基因敲除鼠骨代謝的影響[D];南華大學(xué);2007年

9 陸琳松;唑來膦酸治療維吾爾族絕經(jīng)后婦女骨質(zhì)疏松的臨床觀察[D];新疆醫(yī)科大學(xué);2014年

10 肖平森;集成愈傷片治療骨質(zhì)疏松性椎體壓縮性骨折（肝腎不足兼瘀血阻絡(luò)）PKP術(shù)后的臨床研究[D];湖南中醫(yī)藥大學(xué);2014年

，

本文編號(hào)：2251465