腰椎滑脱伴骨质疏松症患者TLIF术后应用特立帕肽治疗的临床研究

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摘要目的观察特立帕肽联合经椎间孔椎体间融合术（TLIF）治疗腰椎滑脱伴骨质疏松症的临床效果。方法选取我院2012年1月～2015年12月收治的62例腰椎滑脱并骨质疏松症患者作为研究对象，按照随机方法分为特立帕肽组（31例）与对照组（31例）。入选患者均行经椎间孔椎体间融合术，特立帕肽组术后第1天起给予特立帕肽注射液20 μg/次，皮下注射，1次/d，疗程6个月，并口服钙尔奇D3片600 mg，1次/d。对照组仅口服钙尔奇D3片600 mg，1次/d。术后随访1年，分别于3、6、9、12个月时复查，比较两组的ODI功能评分、影像学评价、腰椎骨密度及骨代谢标志物βCross Laps和N-MID Osteocalcin。结果两组术后的ODI评分低于术前，差异有统计学意义（P＜0.05）。术后 3、6、9、12 个月时特立帕肽组的 ODI评分低于对照组，差异有统计学意义（P＜0.05）。特立帕肽组椎弓根螺钉松动、椎间融合器下沉及新发椎体压缩性骨折的发生率均低于对照组，差异有统计学意义（P＜0.05）。至术后12个月时，特立帕肽组的融合率为96.67%，高于对照组的89.66%，差异有统计学意义（P＜0.05）；特立帕肽组的融合时间短于对照组，差异有统计学意义（P＜0.05）。特立帕肽组术后3个月时的骨密度（L1～4）与术前比较，差异无统计学意义（P＞0.05）。术后 6、9、12个月时，特立帕肽组的骨密度（L1～4）高于术前及对照组，差异有统计学意义（P＜0.05）；对照组各时间点的骨密度（L1～4）与术前比较，差异无统计学意义（P＞0.05）。术后复查各时间点，特立帕肽组的血清βCross Laps、N-MID Osteocalcin水平均低于术前，差异有统计学意义（P＜0.05）；对照组的血清βCross Laps、N-MID Osteocalcin水平与术前比较，差异无统计学意义（P＞0.05）。结论特立帕肽联合TLIF治疗腰椎滑脱伴骨质疏松症有确切效果。特立帕肽可有效提高腰椎骨密度，促进植骨融合，降低内固定移位及椎体压缩性骨折的发生率。

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	刘汉辉
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关键词 ：腰椎滑脱, 骨质疏松, 经椎间孔椎体间融合术, 特立帕肽

Abstract：Objective To observe the clinical efficacy of application of combination of Teriparatide and transforaminal lumbar interbody fusion (TLIF)in the treatment of lumbar spondylolisthesis accompanied with osteoporosis.Methods Altogether 62 cases of lumbar spondylolisthesis patients accompanied with osteoporosis who were treated in our hospital from January 2012 to December 2015 were selected as the subjects of this research and divided into the Teriparatide group(31 cases)and the control group(31 cases)according to the random method.All the recruited patients were treated with TLIF.Since the post-operative first day,The Teriparatide group was administered with subcutaneous injection of Teriparatide injection at the dose of 20 μg once a day for 6 months and oral medication of Caltrate D3tablets at the dose of 600 mg once a day.The control group only took orally 600 mg of Caltrate D3tablets once a day.During 1-year follow-up,all the patients were reexamined at post-operative 3,6,9 and 12 months.The Oswestry disability index(ODI)function score and imaging evaluation were compared between the two groups,the lumbar bone mineral density(BMD)and biomarker of bone metabolism such as β Cross Laps and N-MID Osteocalcin were determined.Results The postoperative ODI function scores of the two groups were lower than those before operation,with statistically significant difference (P＜0.05).At post-operative 3,6,9 and 12 months,the ODI score of the Teriparatide group was lower than that of the control group (P＜0.05).The incidences of pedicle screw loosening,interbody fusion cage sinking and new vertebral compression fractures of the Teriparatide group were lower than those of the control group,with statistically significant difference(P＜0.05).At post-operative 12 months,the fusion rate of the Teriparatide group was 96.67%,which was higher than that of the control group (89.66%),with statistically significant difference (P＜0.05).The fusion time of the Teriparatide group was(3.9±0.7)months,which was lower than that of the control group[(4.7±1.3)months],with statistically significant difference(P＜0.05).There was no significant difference in the BMD(L1-4)of the Teriparatide group between post-operative 3 months and before the operation (P＞0.05).At post-operative 6,9 and 12 months,the BMD (L1-4)of the Teriparatide group was higher than that before the operation and that of the control group,with statistically significant difference(P＜0.05).The BMD(L1-4)of the control group at each time point had no statistically significant difference(P＞0.05)compared with that before the operation.At each post-operative reexamination time point,the levels of serum β Cross Laps and N-MID Osteocalcin of the Teriparatide group were lower than those before the operation,with statistically significant difference(P＜0.05).The control group had no statistically significant difference in the levels of serum β Cross Laps and N-MID Osteocalcin(P＞0.05).Conclusion It is effective to treat lumbar spondylolisthesis associated with osteoporosis with application of combination of TLIF and Teriparatide.Teriparatide can effectively improve the lumbar spine bone mineral density,promote bone graft fusion and reduce the incidence of internal fixation displacement and vertebral compression fractures.

Key words： Lumbar spondylolisthesis Osteoporosis Transforaminal lumbar interbody fusion Teriparatide

引用本文:

刘汉辉;赵晓东;陈光福;付美奇. 腰椎滑脱伴骨质疏松症患者TLIF术后应用特立帕肽治疗的临床研究[J]. 中国当代医药, 2018, 25(19): 12-16.
LIU Han-hui;ZHAO Xiao-dong;CHEN Guang-fu;FU Mei-qi. Clinical study of post-TLIF application of Teriparatide in the treatment of lumbar spondylolisthesis patients accompanied with osteoporosis. 中国当代医药, 2018, 25(19): 12-16.

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