Restoration of the intravertebral stability in Kummell's disease following the treatment of severe postmenopausal osteoporosis by 1-34PTH-a retrospective study
Restoration of the intravertebral stability in Kummell's disease following the treatment of severe postmenopausal osteoporosis by 1-34PTH-a retrospective study
复制标题
1-34PTH治疗绝经后严重骨质疏松症恢复Kummell病椎内稳定性的回顾性研究
DOI：
10.1007/s00198-020-05761-x
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发表时间：
2021-01-20
影响因子：
4
通讯作者：
Xue, Y.
中科院分区：
文献类型：
--
作者：
Gou, P.;Wang, Z.;Xue, Y.
在应用1-34PTH保守治疗Kummell病后，椎体内裂隙被骨组织填充或桥接；没有进一步塌陷的放射学证据。对21例绝经后骨质疏松症(PMOP)患者进行1~34PTH治疗，观察治疗前后骨折愈合情况及骨密度(BMD)的变化。结果从基线到12个月，视觉模拟评分由8.24+/-0.54降至1.71+/-0.56(P<；0.001)，改良日本骨科学会评分由6.86+/-1.77升至10.43+/-1.29(P<；0.001)。矢状位CT显示所有患者的下腔静脉均被骨组织充填或桥接。在椎体内，下腔静脉面积从4.5±102.23 mm(2)减少到0 mm(2)(P=0.001)，矿化骨面积从4.5±-102.23 mm(2)增加到259.56±98.60 mm(2)(P=0.001)。下腔静脉与椎体的面积比由0.97±0.46降至0%(P<；0.001)，矿物质骨与椎体的面积比由32.85±14.51升至54.97±14.01%(P<；0.001)。后凸角度增加3.43±1.80°，前缘高度丢失率11.14±4.82%。后缘高度和椎管直径无明显差异。PINP、β-CTX、BMD、简明健康状况调查表评分均显著升高。结论1-34PTH治疗KD合并重度PMOP患者，可缓解临床症状，促进椎体内稳定性的恢复，改善骨密度，改善HRQOL。
Following the 1-34PTH application for conservative treatment of Kummell's disease, the intravertebral cleft was filled or bridged by the osseous tissue; the radiological evidence of further collapsing was absent. Pain and the neurological disorder were relieved; bone turnover markers, BMD as well as the health-related quality of life were improved.Introduction Kummell's disease (KD) patients with severe osteoporosis were applied by the 1-34PTH; the fracture union and the increased bone mineral density (BMD) following this treatment were retrospectively reviewed.Methods Twenty-one postmenopausal osteoporosis (PMOP) patients with KD received at least 6 months of 1-34PTH treatment. The medical records, including clinical evaluation symptoms, radiological evaluation for bone union and the stability of intravertebral vacuum cleft (IVC), BMD, and laboratory examination for osteoporosis recovery and health-related quality of life (HRQOL), were reviewed.Results From baseline to month 12, visual analog scale decreased from 8.24 +/- 0.54 to 1.71 +/- 0.56 (P < 0.001) and the modified Japanese Orthopedic Association scores increased from 6.86 +/- 1.77 to 10.43 +/- 1.29 (P < 0.001). Sagittal CT demonstrated that the IVC was filled or bridged by the osseous tissue in all patients. Within the vertebra, the IVC area (IVCA) decreased from 4.50 +/- 2.50 to 0 mm(2) (P = 0.001) and the mineralized bone area (MBA) increased from 170.91 +/- 102.23 to 259.56 +/- 98.60 mm(2) (P < 0.001). The area ratio of IVC to vertebra decreased from 0.97 +/- 0.46 to 0% (P < 0.001), and the area ratio of mineral bone to vertebra was increased from 32.85 +/- 14.51 to 54.97 +/- 14.01% (P < 0.001). The kyphosis angle increment was 3.43 +/- 1.80 degrees, and the loss rate of anterior border height was 11.14 +/- 4.82%. No differences were found in posterior border height and spinal canal diameter. The PINP, beta-CTx, BMD, and Short Form-36 Health Survey scores markedly increased.Conclusions In KD patients with severe PMOP, 1-34PTH treatment could alleviate the clinical evaluation symptoms, facilitate the recovery of the intravertebral stability, ameliorate the BMD, and improve the HRQoL.