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目的评价不同剂量硝酸甘油对骨质疏松骨折术后的辅助治疗作用。方法选取2014年5~12月医院收治的经皮椎体成形术(PVP)治疗的骨质疏松性脊柱压缩性骨折患者76例,据入院顺序随机将患者分为小剂量组、大剂量组各38例,术后2组患者给予常规治疗,小剂量组舌下含服硝酸甘油0.125mg,每天1次,大剂量组0.25mg,每天1次,连续16周。比较2组治疗前后碱性磷酸酶水平,治疗前后采用双能X线吸收法测定骨密度值测量手术椎体骨密度水平,观察后凸Cobb角度。治疗后观察再骨折及心血管并发症发生情况。结果治疗后2组碱性磷酸酶水平低于治疗前,手术椎体骨密度水平高于治疗前,且大剂量组变化幅度大于小剂量组(P<0.05);小剂量组治疗后后凸Cobb角度大于治疗前及大剂量组治疗后,差异均有统计学意义(P<0.05)。大剂量组治疗前后后凸Cobb角度变化差异无统计学意义(P>0.05)。末次随访(16.3±5.2)个月,2组均未见再骨折、心血管并发症。结论骨质疏松骨折术后辅助应用硝酸甘油可增强骨吸收代谢,加速骨质改善,若条件合适,可增加剂量,以利于病变椎体骨密度快速上升。
Objective To evaluate the adjuvant therapeutic effect of different doses of nitroglycerin on osteoporotic fracture. Methods Seventy-six patients with osteoporotic vertebral compression fractures treated by percutaneous vertebroplasty (PVP) admitted to our hospital from May to December in 2014 were randomly divided into two groups: low-dose group and high-dose group Thirty-eight patients were given conventional therapy after operation. The low-dose group received sublingual nitroglycerin 0.125 mg once daily and high-dose group 0.25 mg once daily for 16 weeks. The levels of alkaline phosphatase in the two groups before and after treatment were compared. The bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry before and after treatment. The Cobb angle was observed. After treatment, observe the occurrence of further fracture and cardiovascular complications. Results After treatment, the level of alkaline phosphatase in the two groups was lower than that before treatment, and the vertebral bone density was higher in the high-dose group than in the low-dose group (P <0.05). After treatment, the Cobb The difference was statistically significant (P <0.05) when the angle was greater than before treatment and after treatment with high-dose group. There was no significant difference in the angle of kyphosis before and after treatment in high-dose group (P> 0.05). At the last follow-up (16.3 ± 5.2) months, no further fractures and cardiovascular complications were found in the two groups. Conclusion The postoperative application of nitroglycerin to osteoporosis fracture can enhance the bone resorption and metabolism and accelerate the improvement of the bone quality. If the condition is right, the dosage can be increased to facilitate the rapid rise of vertebral bone density.