特立帕肽联合依降钙素对骨质疏松患者内镜下腰椎椎间融合术后疗效的影响

Effect of teriparatide combined with elcatonin on the clinical efficacy after endoscopic lumbar interbody fusion in patients with osteoporosis

中文关键词:  骨质疏松  特立帕肽  依降钙素  内镜下腰椎椎间融合术

英文关键词:Osteoporosis  Teriparatide  Elcatonin  Endoscopic lumbar interbody fusion

中文摘要:

  【摘要】 目的：观察特立帕肽联合依降钙素对骨质疏松患者行内镜下腰椎椎间融合（endoscopic lumbar interbody fusion，Endo-LIF）术后疗效的影响。方法：收集2021年7月~2023年2月在佛山市健翔骨伤医院行经后方椎间孔入路Endo-LIF（Endo-P/TLIF）手术的60例腰椎椎管狭窄症合并骨质疏松的患者，其中30例在术后给予维生素D+钙剂+依降钙素治疗3个月，纳入对照组（男6例，女24例，年龄67.0±6.6岁；单节段12例，双节段18例）；30例在术后给予特立帕肽+依降钙素+维生素D+钙剂治疗3个月，纳入观察组（男7例，女23例，年龄66.0±5.9岁，单节段10例，双节段20例）。两组患者年龄、性别比、术前骨密度T值和手术节段均无统计学差异（P>0.05）。统计所有患者治疗前、治疗后1个月和3个月时疼痛模拟量表（visual analogue scale，VAS）评分、Oswestry功能障碍指数（Oswestry disability index，ODI）、全身骨代谢指标[1型前胶原氨基末端前肽（P1NP）、β胶原降解产物（β-CTX）、骨钙素（BGP）和2，5羟基维生素D（2，5（OH）VitD）]，治疗后3个月时椎间融合情况，治疗后6个月时的骨密度T值。应用t检验或卡方检验比较两组间的差异。结果：两组患者治疗前VAS评分、ODI、骨代谢指标和骨密度T值均无统计学差异（P>0.05）。治疗后1个月和3个月时，两组VAS评分和ODI均显著性降低，同时间点观察组下降幅度较对照组更明显（P＜0.05）。观察组治疗后1个月和3个月时P1NP、β-CTX、BGP和2，5（OH）VitD较治疗前均显著性升高（P＜0.05）；对照组治疗后3个月BGP和2，5（OH）VitD较治疗前显著性升高（P＜0.05）；治疗后3个月时观察组P1NP、β-CTX、BGP均显著性高于对照组（P＜0.05），两组同时间点2，5（OH）VitD无统计学差异（P＞0.05）。治疗后3个月时观察组椎间融合率显著性高于对照组（96.66% vs 80.00%，P<0.05）。治疗后6个月观察组骨密度T值显著性高于对照组（-2.76±0.37 vs －3.06±0.42，P＜0.05）。结论：特立帕肽联合依降钙素能更好改善骨质疏松患者行Endo-P/TLIF术后的临床症状、骨密度T值和全身骨代谢指标，提高早期椎间融合率。

英文摘要:

  【Abstract】 Objectives: To observe the effect of teriparatide and elcatonin on the efficacy of endoscopic lumbar interbody fusion(Endo-LIF) in patients with osteoporosis. Methods: A total of 60 patients diagnosed with lumbar spinal stenosis combined with osteoporosis undergone Endo- LIF via posterior transforaminal approach (Endo-P/TLIF) in Foshan Jianxiang Orthopedics Hospital between July 2021 and February 2023 were collected. Among the patients, 30 treated with vitamin D + calcium + elcatonin for 3 months after operation were included in the control group(6 males, 24 females, aged 67.0±6.6 years; 12 involved single segments, 18 involved double segments); 30 treated with teriparatide + elcatonin + vitamin D + calcium for 3 months after operation were included in the observation group(7 males, 23 females, aged 66.0±5.9 years; 10 involved single segments, 20 involved double segments). There were no statistical differences in age, sex ratio, bone mineral density(BMD) before treatment and surgical segments between the two groups(P>0.05). The visual analogue scale(VAS) score, Oswestry disability index(ODI), and systemic bone metabolism indexes[P1NP, β -CTX, BGP, 2,5(OH)VitD] were counted before and at 1 month and 3 months after treatment. The intervertebral body fusion at 3 months after treatment, and the T values of BMD before and at 6 months after treatment were also collected and evaluated. A t-test or chi-square test was applied to compare the differences between the two groups. Results: There were no statistical differences in VAS scores, ODIs, bone metabolism indexes, and T values of BMD between the two groups before treatment(P>0.05). At 1 and 3 months after treatment, the VAS scores and ODIs were significantly reduced in both groups, with the decrease in the observation group more significantly than that in the control group at the same time point(P<0.05). P1NP, β-CTX, BGP and 2,5(OH)VitD in the observation group were significantly higher at 1 and 3 months after treatment compared with before treatment(P<0.05). BGP and 2,5(OH)VitD in the control group increased significantly at 3 months after treatment compared with before treatment(P<0.05). P1NP, β-CTX and BGP were higher in the observation group than in the control group at 3 months after treatment(P<0.05). There was no statistical difference in 2,5(OH)VitD at the same time point between the two groups(P>0.05). The intervertebral fusion rate in the observation group was significantly higher than that of the control group at 3 months after treatment(96.66% vs 80.00%, P<0.05). The T value of BMD in the observation group was significantly higher than in the control group at 6 months after treatment(-2.76±0.37 vs 3.06±0.42, P<0.05). Conclusions: Teriparatide combined with elcatonin can improve the clinical symptoms, bone mineral density, and systemic bone metabolism index changes, and enhance early interbody fusion rate after Endo-P/TLIF in osteoporosis patients.