降钙素在老年不稳定型股骨转子间骨折应用

Application of calcitonin for the treatment of unstable intertrochanteric fractures in elderly patients

目的比较采用股骨近端防旋转髓内钉（proximalfemoralnailantirotation，PFNA）联合鲑鱼降钙素与单纯行PFNA治疗老年不稳定型股骨转子间骨折的临床疗效。方法前瞻性研究2009年1月至2011年12月，采用PFNA治疗120例老年不稳定型股骨转子间骨折患者资料。术前随机将患者分为降钙素组（PFNA治疗联合应用鲑鱼降钙素）和对照组（单纯PFNA治疗）。降钙素组60例，男28例，女32例；年龄71-82岁，平均75．1岁；Evans-Jensen分型：ⅡA型20例，IIB型32例，Ⅲ型8例。对照组60例，男27例，女33例；年龄70--83岁，平均74．9岁；Evans-Jensen分型：ⅡA型22例，ⅡB型32例，Ⅲ型6例。两组患者均为低能量损伤。术后观察骨折愈合情况，测量健侧髋关节骨密度，记录患者Harris评分及SF一12量表评分，记录手术相关并发症、药物不良反应与其他部位骨折等情况。结果113例患者获得至少2年以上的完整随访，降钙素组55例，对照组58例。除对照组4例骨折延迟愈合外，其余患者术后6个月x线片均示骨折愈合良好；术后1年，所有患者骨折均愈合。术前降钙素组健侧髋部平均骨密度T值为-2．54~0．35，对照组为一2．53~0．27；术后6个月、1年、2年降钙素组健侧髋部平均骨密度T值分别为一1．82~0．27、1．33~0．23、-1．17~0．16，对照组分别为一2．14~0．32、一1．91~0．23、一2．01＋O．27，降钙素组患者骨密度明显提高。术后两组患者Harris评分和术后1年sF．12量表评分比较，差异均无统计学意义。术后2年两组患者SF．12量表评分比较，差异有统计学意义。降钙素组仅1例患者术后3个月发生桡骨远端骨折，对照组术后13～23个月，4例发生腰椎压缩性骨折，1例发生桡骨远端骨折，1例发生健侧髋部骨折。结论PFNA治疗老年不稳定型股骨转子间骨折具有固定牢靠，骨折愈合率高等优点，而联合鲑鱼降钙素治疗，可有效改善患者骨密度，提高骨折愈合质量，降低再骨折风险，提高患者生活质量。

Objective To compare the clinical outcomes between proximal femoral nail antirotation （PFNA） combined with salmon calcitonin and PFNA only for the treatment of unstable intertrochanteric fractures in elderly patients. Methods From January 2009 to December 2011, 120 elderly patients with intertrochanteric fracture were randomly divided into two groups： calcitonin group and control group. Patients in calcitonin group were treated with PFNA combined with salmon calcitonin, while patients in control group were treated with PFNA only. According to Evans-Jensen classification, 60 patients in calcitonin group （28 males and 32 females, with an average age of 75.1 years） were divided into 20 cases of type I1 A, 32 cases of type 11 B and 8 type 11I. Sixty patients in control group （27 males and 33 females, with an average age of 74.9 years） were divided into 22 cases of type lI A, 32 cases of type ]I B and 6 type In. Bone healing was assessed with X-ray and bone mineral density （BMD） was mea- sured by dual energy X-ray absorptiometry. Harris hip and SF-12 score, complications, adverse effect of salmon calcitonin and sub- sequent fragility fractures were evaluated postoperatively. Results One-hundred and thirteen patients were followed up for at least 2 years. In 6 months after surgery, there were 4 cases of delayed healing in control group. However, all fractures were healed in 12 months after surgery. No significant difference was found between the two groups in BMD preoperatively. The changes in BMD were significantly different between the two groups in 6 months, 1 year and 2 years after surgery. No significant difference was found between the two groups in Harris hip and 1-year SF-12 score while the 2-year SF-12 score was significantly different be- tween the two groups. There was 1 patient in calcitonin group who suffered from subsequent fragility fracture in 3 months after sur- gery, while there was 6 patients in control group during 13 to 23 months postoperatively. Conclusion PFNA combined with salm- on calcitonin achieves good effect for the treatment of unstable intertrochanteric fractures in elderly patients.