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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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

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	Articles by authors
	LIU Han-hui
	ZHAO Xiao-dong
	CHEN Guang-fu
	FU Mei-qi

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LIU Han-hui,ZHAO Xiao-dong,CHEN Guang-fu, et al. Clinical study of post-TLIF application of Teriparatide in the treatment of lumbar spondylolisthesis patients accompanied with osteoporosis[J]. 中国当代医药, 2018, 25(19): 12-16.

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http://dangdaiyiyao.com/EN/ OR http://dangdaiyiyao.com/EN/Y2018/V25/I19/12

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