帕米膦酸二钠治疗骨纤维结构不良的观察

An observation on pamidronate used for treatment of osteofibrous dysplasia

摘要:

［目的］探讨帕米膦酸二钠治疗骨纤维结构不良的临床疗效。［方法］回顾性分析 2011 年 1 月—2021 年 1 月本科采用静脉滴注帕米膦酸二钠治疗的 38 例骨纤维结构不良患者的临床资料。［结果］1 例患者首次用药时出现发热。5 例患者用药期间出现病理性骨折，其中 4 例行刮除植骨内固定术，1 例行单纯髓内针内固定术。随访 12~48 个月，平均（30.79±13.03）个月。随时间推移，VAS 评分显著降低（P<0.05），而 SF-36 评分显著升高（P<0.05）；血清 I 型胶原 C 端肽和血清 I 型胶原 N 端肽显著降低（P< 0.05），但是血清骨钙素无显著变化（P>0.05）。影像方面，与治疗前相比，用药 6 个月后 3 例患者病变区域缩小，32 例患者病变区域无变化，3 例患者的病变区域扩大；末次随访时，7 例患者病变区域缩小，27 例患者病变区域无变化，4 例患者的病变区域扩大。［结论］帕米膦酸二钠治疗骨纤维结构不良能够减轻患者疼痛，降低骨代谢指标，延缓疾病的进展，并且不良反应轻微。

Abstract:

[Objective] To investigate the clinical efficacy of pamidronate used for the treatment of osteofibrous dysplasia (OFD) . [Methods] A retrospective study was performed on 38 patients who received pamidronate intravenously for OFD in our department from Jan- uary 2011 to January 2021. [Results] Fever occurred in 1 patient at the time of first medication. Pathological fractures occurred in 5 patients during the treatment period, which in 4 patients underwent curettage, bone graft and internal fixation, while the other one received intramed- ullary nailing for internal fixation only. With time of follow- up lasted for 12~48 months with a mean of (30.79±13.03) months, the VAS scores decreased significantly (P<0.05) , while the SF-36 score increased significantly (P<0.05) ; in addition, serum C-terminal type I pro- collagen (C1NP) and serum N-terminal propeptide of type I procollagen (PINP) significantly decreased (P<0.05) , whereas the serum osteo- calcin remained unchanged (P<0.05) . Compared with that before treatment, the lesion area on radiographs reduced in 3 patients, remained unchanged in 32 patients, and enlarged in 3 patients at 6 months after treatment, whereas reduced in 7 patients, unchanged in 27 patients, and enlarged in 4 patients at the latest follow-up. [Conclusion] The pamidronate used for the treatment of OFD does relieve pain, decline bone metabolic markers and delay the progression of the disease with mild adverse reactions.