甲状旁腺激素(1-34)在治疗胸腰椎骨质疏松性椎体压缩骨折经皮椎体后凸成形术后邻近椎体再骨折中的应用

目的观察甲状旁腺激素(PTH)(1-34)在治疗胸腰椎骨质疏松性椎体压缩骨折(OVCF)经皮椎体后凸成形术(PKP)后邻近椎体再骨折中的效果。方法回顾性分析2014年1月至2018年6月山西白求恩医院骨科收治的43例胸腰椎OVCF PKP术后邻近椎体再骨折患者资料。其中男14例,女29例;年龄平均73.7岁(61~84岁);邻近椎体再骨折部位:T91例,T102例,T117例,T1214例,L112例,L24例,L32例,L41例。根据治疗方式不同分为3组:A组行PKP治疗(22例),B组行PKP+PTH(1-34)治疗(9例),C组行PTH(1-34)治疗(12例)。记录并比较3组患者入院时、术后6个月X线椎体前缘、中线高度及后凸cobb角,入院时及治疗后6、12个月左侧髋部骨密度,入院时、治疗后3、6、12个月视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)评分。结果3组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。A组中有3例患者再次出现邻近椎体压缩骨折,B、C组中未出现再次OVCF。A、B组治疗后6个月时椎体高度及后凸cobb角均较入院时改善,差异有统计学意义(P<0.05),而C组无改善。B组治疗后6、12个月及C组治疗后12个月时骨密度T值较入院时改善,差异均有统计学意义(P<0.05),而A组无改善。3组患者的VAS、ODI评分较入院时改善,差异均有统计学意义(P<0.05)。结论PTH(1-34)治疗胸腰椎OVCF PKP术后邻近椎体再骨折可明显改善老年骨质疏松患者的骨密度,防止伤椎塌陷并减少PKP术后骨折患者邻近椎体再骨折。PTH(1-34)结合PKP还可以恢复椎体高度,减少椎体后凸畸形,是治疗OVCF PKP再骨折有效的治疗方法。

Parathyroid hormone 1-34 in the treatment of adjacent vertebral refracture after percutaneous kypho-plasty for thoracolumbar osteoporotic compression fracture

Objective To evaluate the efficacy of parathyroid hormone 1-34(PTH1-34)in the treat-ment of adjacent vertebral refracture after percutaneous kyphoplasty(PKP)for thoracolumbar osteoporotic com-pression fracture(OVCF).Methods A retrospective study was made of the 43 OVCF patients who had been admitted to Department of Orthopedics,Shanxi Bethune Hospital for adjacent vertebral refracture after PKP from January 2014 to June 2018.Of them,22 were treated by secondary PKP(group A),9 by secondary PKP+PTH1-34(group B),and 12 by merely PTH1-34(group C).The vertebral heights of anterior border and middle-line and sagittal kyphosis cobb angle on X-ray films at 6 months after operation,the bone mineral den-sities of the left hip at admission,6 and 12 months after operation,and the Oswestry Dysfunction Index(ODI)and Visual Analog Scale(VAS)scores at admission,3,6 and 12 months after operation were recorded and compared.Results The 3 groups were compatible because there were no significant differences between them in the preoperative general data(P>0.05).Recurrent OVCF was found in 3 patients in group A but not in group B or C.The vertebral heights and kyphosis cobb angle at 6 months after operation were significantly improved compared to the preoperative values in groups A and B(P<0.05)but not in group C.The T values of bone mineral density at 6 and 12 months after operation in group B and at 12 months after operation in group C were significantly improved compared to their preoperative ones(P<0.05)but not in group A.The post-operative ODI and VAS scores were significantly improved compared to the scores at admission in all the 3 groups(P<0.05).Conclusions In the treatment of adjacent vertebral refracture after PKP for elderly OVCF patients,PTH1-34 can significantly improve their bone mineral density,prevent collapse of the injured vertebra and reduce re-fracture of adjacent vertebral body.A combination of PTH1-34 and PKP is an effective treatment of adjacent vertebral refracture after PKP because it can restore the vertebral heights and reduce kyphosis deformity.