CAJ | 학술논문

目的：探讨唑来膦酸对骨质疏松患者腰椎融合术后植骨融合的影响。方法回顾性分析2010年1月至2011年3月因腰椎间盘退变性疾病合并绝经后骨质疏松症患者的病例资料共36例。患者均采用后路腰椎板切除减压、椎间及后外侧植骨融合、椎弓根钉棒内固定术。术后1～2周给予唑来膦酸注射液5mg静脉滴注，同时每天补充元素钙1000 mg和维生素D3400 U。比较术前与术后3、6、12个月时功能障碍指数（ ODI ）评分与骨转换生化标志物变化。比较术前与术后12个月骨密度变化。分析随访期末时的植骨融合情况。结果36例患者均获得随访，平均年龄（63.18±6.97）岁。术前ODI评分平均为（38.36±5.95）分，术后3个月为（14.36±5.22）分，术后6个月为（9.00±6.07）分，术后12个月为（9.18±6.65）分。术后各时间点ODI评分与术前相比差异均有统计学意义（均P＜0.05）。术后3、6个月ODI评分持续下降，6个月达平台期，与12个月相比差异无统计学意义（ P＞0.05）。骨转换生化标志物血清β-Ⅰ型胶原交联羧基末端肽（β-CTX）、Ⅰ型原胶原氨基端前肽（PINP）术后3个月显著降低（P＜0.05），6、12个月时缓慢升高，但均保持在绝经后正常范围内。术前髋部和股骨颈骨密度为（0.721±0.16）和（0.687±0.19） g/cm2，术后12个月提高至（0.746±0.16）和（0.714±0.17） g/cm2（P＜0.05）。34例患者获得坚实融合，2例未融合，融合率为94.4％（34/36）。结论唑来膦酸抗骨质疏松作用显著，骨质疏松患者术后早期应用唑膦酸对腰椎融合无不利影响。
목적：탐토서래련산대골질소송환자요추융합술후식골융합적영향。방법회고성분석2010년1월지2011년3월인요추간반퇴변성질병합병절경후골질소송증환자적병례자료공36례。환자균채용후로요추판절제감압、추간급후외측식골융합、추궁근정봉내고정술。술후1～2주급여서래련산주사액5mg정맥적주，동시매천보충원소개1000 mg화유생소D3400 U。비교술전여술후3、6、12개월시공능장애지수（ ODI ）평분여골전환생화표지물변화。비교술전여술후12개월골밀도변화。분석수방기말시적식골융합정황。결과36례환자균획득수방，평균년령（63.18±6.97）세。술전ODI평분평균위（38.36±5.95）분，술후3개월위（14.36±5.22）분，술후6개월위（9.00±6.07）분，술후12개월위（9.18±6.65）분。술후각시간점ODI평분여술전상비차이균유통계학의의（균P＜0.05）。술후3、6개월ODI평분지속하강，6개월체평태기，여12개월상비차이무통계학의의（ P＞0.05）。골전환생화표지물혈청β-Ⅰ형효원교련최기말단태（β-CTX）、Ⅰ형원효원안기단전태（PINP）술후3개월현저강저（P＜0.05），6、12개월시완만승고，단균보지재절경후정상범위내。술전관부화고골경골밀도위（0.721±0.16）화（0.687±0.19） g/cm2，술후12개월제고지（0.746±0.16）화（0.714±0.17） g/cm2（P＜0.05）。34례환자획득견실융합，2례미융합，융합솔위94.4％（34/36）。결론서래련산항골질소송작용현저，골질소송환자술후조기응용서련산대요추융합무불리영향。
Objective To explore the effect of zoledronic acid on lumbar spinal fusion for patients with osteo-porosis .Methods From January 2010 to March 2011, 36 women with postmenopausal osteoporosis suffering from lumbar disc degenerative diseases were analyzed .All patients underwent posterior lumbar discectomy , decompression , intervertebral and posterolateral bone graft fusion and pedicle screw fixation .One to two weeks after surgery , all patients received 5 mg zoledronic acid infusion plus daily element calcium 1000 mg and vitamin D3 400 IU.Compare the ODI scores and biochemical markers of bone turnover before and 3 months、 6 months and 12 months after surgery .The chan-ges of bone mineral density before and 12 months after treatment were also compared .The solid fusion rate was analyzed . Results Thirty-six patients with an average age of 63.18 ±6.97 were followed .The ODI scores of pre-operation, 3 months , 6 months and 12 months after operation were 38.36 ±5.95 , 14.36 ±5.22 , 9.00 ±6.07 and 9.18 ±6.65 .Sig-nificant difference was achieved regarding to the ODI scores at any follow-up time compared with that of pre-operation (P<0.05).The ODI scores declined obviously 3 months and 6 months after surgery, reaching to a plateau at 6 months,showing no significance compared with the scores of 12 months after surgery .The biochemical markers of bone turnover β-C-terminal crosslink of type Ⅰcollagen (β-CTX) , Amino-terminal propeptide of type I collagen ( PINP) decreased sig-nificantly at 3 months ( P<0.05 ) , then increased slightly , remaining in the normal range of post menopause 6 and 12 months after surgery.Bone mineral density of hip and femoral neck were improved from (0.721 ±0.16) and (0.687 ± 0.19) g/cm2 to (0.746 ±0.16) and (0.714 ±0.17) g/cm2 (P<0.05).Thirty-four patients achieved solid fusion, with a fusion rate of 94.4%(34/36).Conclusion The anti-osteoporosis efficacy of zoledronic acid was significant and no negative effect was observed for lumbar spinal fusion .