Ding Qirui, Chen Jian, Fan Jin, Li Qingqing, Yin Guoyong, Yu Lipeng
Department of Orthopedic, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210000, Jiangsu, People's Republic of China.
Eur Spine J. 2017 Nov;26(11):2969-2977. doi: 10.1007/s00586-017-5286-1. Epub 2017 Sep 1.
To investigate the effect of zoledronic acid (ZA) on lumbar spinal fusion in patients with osteoporosis.
This retrospective study includes 94 osteoporotic patients suffering from lumbar degenerative diseases or lumbar fracture who underwent lumbar spinal fusion in our institution from January 2013 to August 2014. They were divided into ZA group and control group according to whether the patient received ZA infusion or not. The patients in ZA group were given 5 mg intravenous ZA at the 3rd-5th days after operation. All patients took daily oral supplement of 600 mg calcium carbonate and 800 IU vitamin D during the follow-up after operation. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Short Form 36 (SF-36) scores were recorded preoperatively and post-operatively to evaluate the clinic outcomes; the spinal fusion was assessed by X-ray or CT Scan.
64 patients finished the final follow-up, including 30 patients in ZA group and 34 patients in control group. No significant difference was observed in gender, age, and preoperative BMI VAS, ODI, and SF-36 scores between the two groups (P > 0.05). The post-operative VAS and ODI scores decreased rapidly at 3 and 6 months, but rose back slightly at 12 and 24 months in both groups. On the contrary, post-operative SF-36 scores increased rapidly at 3 and 6 months, while fell back slightly at 12 and 24 months, with a statistically significant difference between the two groups at 12 months, but not at 3 and 6 month post-operation. The spinal fusion rate in ZA group was 90% at 6 months, 92% at 12 months, while it was 75% at 6 months, 92.86% at 12 months in control group, significantly different between the two groups at 12 months, but not at 6 months. In the whole follow-up period, adjacent vertebral compressing fracture occurred in five patients in control group, none in ZA group. No pedicle screw loosening was observed in ZA group, with six in control group.
Zoledronic acid accelerates spinal fusion, shortens the time of fusion without changing fusion rate, and also decreases the risk of adjacent vertebral compressing fracture and the rate of pedicle screw loosening, resulting in the improvement of clinical outcomes and quality of life.
探讨唑来膦酸（ZA）对骨质疏松症患者腰椎融合术的影响。
本回顾性研究纳入了2013年1月至2014年8月在我院接受腰椎融合术的94例患有腰椎退行性疾病或腰椎骨折的骨质疏松症患者。根据患者是否接受ZA输注将其分为ZA组和对照组。ZA组患者在术后第3 - 5天静脉注射5mg ZA。所有患者在术后随访期间每日口服补充600mg碳酸钙和800IU维生素D。记录术前和术后的视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）和简明健康状况调查问卷（SF - 36）评分以评估临床疗效；通过X线或CT扫描评估脊柱融合情况。
64例患者完成了最终随访，其中ZA组30例，对照组34例。两组在性别、年龄、术前BMI、VAS、ODI和SF - 36评分方面无显著差异（P > 0.05）。两组术后VAS和ODI评分在3个月和6个月时迅速下降，但在12个月和24个月时略有回升。相反，术后SF - 36评分在3个月和6个月时迅速上升，而在12个月和24个月时略有下降，两组在术后12个月时有统计学显著差异，但在术后3个月和6个月时无差异。ZA组6个月时脊柱融合率为90%，12个月时为92%；对照组6个月时为75%，12个月时为92.86%，两组在12个月时有显著差异，但在6个月时无差异。在整个随访期间，对照组有5例患者发生相邻椎体压缩性骨折，ZA组无。ZA组未观察到椎弓根螺钉松动，对照组有6例。
唑来膦酸可加速脊柱融合，缩短融合时间且不改变融合率，还可降低相邻椎体压缩性骨折的风险和椎弓根螺钉松动率，从而改善临床疗效和生活质量。
