Efficacy of percutaneous kyphoplasty, zoledronic acid infusion versus their combinations for treating osteoporotic vertebral compression fractures in older adults

doi:10.3969/j.issn.2095-4344.1203

Abstract

Abstract:

BACKGROUND: Vertebroplasty is effective in relieving pain in elderly patients with osteoporotic thoracolumbar fractures, and zoledronic acid is an effective drug for treating osteoporosis.

OBJECTIVE: To investigate the effect of zoledronic acid infusion on radiographic and clinical outcomes after percutaneous kyphoplasty for senile osteoporotic thoracolumbar fractures.

METHODS: We retrospectively analyzed 89 elderly patients (aged > 65 years) with osteoporotic thoracolumbar fractures from August 2013 to June 2015 at Fifth Hospital in Wuhan. Thirty-two patients were treated with percutaneous kyphoplasty and 27 patients received zoledronic acid infusion at 3 days after percutaneous kyphoplasty, and 30 patients were treated with 5 mg zoledronic acid infusion, once yearly. The vertebral height, degree of kyphotic deformity, Visual Analog Scale, Oswestry Disability Index, bone mineral density T-value and complications were evaluated.

RESULTS AND CONCLUSION: (1) The vertebral height, degree of kyphotic deformity, Visual Analog Scale, and Oswestry Disability Index in the percutaneous kyphoplasty and zoledronic acid plus percutaneous kyphoplasty groups were significantly superior to those in the baseline and zoledronic acid group (P < 0.05) at postoperative 1 week, 3, 6, 12 and 24 month. (2) The bone mineral density T-value of lumbar vertebrae at 12 and 24 months postoperatively in the percutaneous kyphoplasty and zoledronic acid plus percutaneous kyphoplasty groups was significantly higher than that at baseline (P < 0.05). (3) The vertebral height, degree of kyphotic deformity, and Oswestry Disability Index at postoperative 24 months in the zoledronic acid plus percutaneous kyphoplasty group were significantly superior to those in the percutaneous kyphoplasty group (P < 0.05). (4) The incidence of vertebral re-fracture in the percutaneous kyphoplasty group was 16%, but no patient with vertebral re-fracture in the zoledronic acid plus percutaneous kyphoplasty group (P < 0.05). (5) In summary, 5 mg zoledronic acid infusion, once yearly combined with percutaneous kyphoplasty can restore vertebral height, reduce kyphotic deformity, alleviate pain, promote functional recovery of spinal cord and reduce vertebral re-fracture in the treatment of senile osteoporotic thoracolumbar fractures.

Key words: senile osteoporotic thoracolumbar fractures, zoledronic acid, percutaneous kyphoplasty, Oswestry Disability Index, Visual Analog Scale, kyphotic deformity, vertebral height

CLC Number:

R459.9

Zhang Mi, Liu Yang, Tan Junfeng, Li Minghui, Liu Libin. Efficacy of percutaneous kyphoplasty, zoledronic acid infusion versus their combinations for treating osteoporotic vertebral compression fractures in older adults [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(16): 2479-2485.

Figures/Tables 6

2.7 目测类比评分术前目测类比评分3组间差异无显著性意义(P > 0.05)，3组术后1周及3，6，12，24个月的目测类比评分均显著低于术前(P < 0.05)。经皮椎体后凸成形组及经皮椎体后凸成形+唑来膦酸组术后1周及3，6，12，24个月的目测类比评分均显著低于唑来膦酸组(P < 0.05)，见表6。 2.8 术前ODI 3组间差异无显著性意义(P > 0.05)，3组术后1周及3，6，12，24个月的ODI均显著低于术前(P < 0.05)。经皮椎体后凸成形组及经皮椎体后凸成形+唑来膦酸组术后1周及3，6，12，24个月的ODI均显著低于唑来膦酸组(P < 0.05)；此外经皮椎体后凸成形+唑来膦酸组术后6，12和24个月的ODI显著低于经皮椎体后凸成形组(P < 0.05)，见表7。 2.9 不良事件此次研究评估了经皮椎体后凸成形术的并发症和唑来膦酸输注的不良事件。经皮椎体后凸成形治疗椎体术后X射线片显示10例患者发生骨水泥外渗，其中经皮椎体后凸成形组4例，经皮椎体后凸成形+唑来膦酸组6例，2组水泥外渗率差异无显著性意义(P > 0.05)。主要是椎旁软组织、静脉丛和相邻椎间盘出现水泥渗漏。此次研究未出现经皮椎体后凸成形的其他并发症如出血、感染、心脏骤停、肺栓塞、脑卒中或椎管渗漏等。在2年的随访期内，经皮椎体后凸成形组5例发生椎体再骨折，椎体再骨折发生率为16%；但椎体后凸成形+唑来膦酸组无压缩性椎体再骨折发生，2组椎体再骨折发生率差异有显著性意义 (P < 0.05)。唑来膦酸输注观察到最常见的不良事件是急性期反应，包括流感样症状，发烧，头痛，恶心，肌痛和关节痛。经皮椎体后凸成形+唑来膦酸组27例患者中有6例、唑来膦酸组30例患者中有5例在注射唑来膦酸后出现发热、头痛及流感样症状，最高体温38.4 ℃，给予适当非类固醇药物对症治疗后11例患者均在3 d内缓解，未发生肾损害、消房颤、下颌骨坏死等严重不良反应，见表8。"

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