了解唑来膦酸钠对经皮穿刺椎体成形术(PVP)术后残余疼痛、胸腰椎小关节紊乱及再发骨折的作用。

收集2020年7月至2021年7月在佛山健翔骨伤医院骨科诊断为骨质疏松性椎体压缩性骨折(OVCF)，并行PVP的患者60名，排除爆裂骨折等其他损伤和激素使用史、肝肾功能障碍及其他严重疾病。依据随机数字表法分为对照组(30名)、治疗组(30名)。对照组给予维生素D₂+钙剂治疗1年；治疗组给予唑来膦酸钠(1次/年)+维生素D₂+钙剂治疗1年。收集两组患者视觉模拟评分、功能障碍评分、胸腰椎小关节紊乱诱发疼痛发生率、骨密度和血清骨代谢指标，并采用独立样本t检验、重复测量方差分析及卡方检验进行统计学处理。

与对照组比较，治疗组的视觉模拟评分(t＝2.867、3.090)、功能障碍评分(t＝2.732、2.277)在治疗后3个月、治疗后1年均有改善(均为P<0.05)。与对照组相比，治疗组治疗后1年胸腰椎小关节紊乱诱发复发性疼痛的发生率明显降低(χ²＝4.8，P<0.05)。与治疗前相比，治疗组在治疗后1年对骨密度的促进作用有统计学意义(t＝－2.723，P<0.05)。与对照组相比，治疗组在治疗后3个月、治疗后1年对β-异构C-端肽(β-CTX)的抑制作用有统计学意义(t＝4.687、2.952，均为P<0.05)，对Ⅰ型前胶原氨基末端(N端)前肽(PINP)、2，5(OH)VitD的促进作用无统计学意义(均为P>0.05)。对照组与治疗组在治疗后1年PINP较治疗前下降(F＝5.697、6.974，均为P<0.05)，但治疗组优于对照组；治疗组在治疗后3个月及治疗后1年β-CTX则较治疗前降低(F＝7.036、5.381，均为P<0.05)；对照组在治疗后3个月2，5(OH)VitD则较治疗前上升(F＝5.915，P<0.05)，治疗后1年较治疗前明显上升(F＝11.690，P<0.01)；治疗组在治疗后3个月及治疗后1年2，5(OH)VitD较治疗前明显上升(F＝10.354、11.935，均为P<0.01)。

唑来膦酸钠可以改善骨质疏松性椎体压缩性骨折患者PVP术后疼痛程度及功能障碍，降低胸腰椎小关节紊乱诱发疼痛发生率，提高患者骨密度水平，明显降低椎体再发骨折风险。

To understand the effect of zoledronate and PVP on relieving postoperative residual pain, thoracolumbar arthropathy disorder and recurrent fractures.

A total of 60 patients diagnosed as osteoporotic vertebral compression fracture(OVCF)in Foshan Jianxiang Orthopedics Hospital from July 2020 to July 2021 and concurrent with PVP were enrolled, and the patients with bursting fractures of ather injuries, glucocorticoid history, severe hepaticor renal dysfuction or other diseases were exduded. The patients were divided into the model group (30) and the treatment group (30) according to random numbers table. The model group received vitamin D₂ + calcium tablets for one year; the treatment group received zoledronic acid (once per year)+ vitamin D₂+ calcium tablets for one year. Visual analogue scale, dysfunction scores, incidence of thoracolumbar facet disorder-induced pain, bone density (BMD) and serum bone metabolism indicators were collected and analyzed by repeated measures ANOVA, t test and chi square test.

Compared with the model groups, the differences of visual analogue score(t=2.867, 3.090) and the dysfunction score (t=2.732, 2.277) were all statistically significant at the first three months and one year after treatment(all P<0.05). The incidence of recurrent pain was significantly reduced one year after the treatment compared with the model group (χ²=4.8, P<0.05). BMD of the treatment group improved one year after the treatment compared with the data before treatment (t=-2.723, P<0.05). The inhibition of beta-isomerized C-telopeptide(β-CTX)was statistically significantly compared with the model group at the first three months and one year after the treatment (t=4.687, 2.952, both P<0.05). There was no statistically significant promotion of procollagen I N-terminal propeptide (PINP) and 2, 5(OH)VitD when compared with the model group(both P>0.05). The PINP decreased one year after the treatment (F=5.697, 6.974, both P<0.05), and the treatment group were better than the model group. The β-CTX of the treatment group decreased three months and one year after the treatment compared with the data before the treatment (F=7.036, 5.381, both P<0.05). In the model group, 2, 5 (OH) VitD increased three months after the treatment (F=5.915, P<0.05) and significantly increased one year after the treatment (F=11.690, P<0.01). In the treatment group, 2, 5(OH) VitD increased significantly three months after treatment and one year after the treatment (F=10.354, 11.935, both P<0.01).

Percutaneous vertebroplasty combined with zoledronic acid can significantly improve the pain and dysfunction of elderly patients with osteoporotic lumbar vertebral compression fracture, reduce the incidence of pain induced by thoracolumbar arthropathy disorder, improve bone density, and reduce the risk of vertebral recurrence fracture.