摘要
目的探究依降钙素联合阿法骨化醇对骨折患者促进骨愈合作用效果的影响。方法选取2014年3月至2015年3月来宜宾市第二人民医院就诊的行内固定术的肱骨干骨折患者98例,按照抽签法分为观察组和对照组,各49例。给予对照组术后常规应用碳酸钙D3片及功能锻炼;观察组在对照组治疗措施的基础上加用依降钙素注射液5 U/次,1次/周,联合阿法骨化醇0.5μg/d,并以0.25μg/d的增量增加至1μg/d后维持。观察比较两组患者治疗前、治疗4周及治疗12周后的腰椎骨密度、血清骨钙素(SOC)、不良反应情况及骨折愈合情况,每周记录两组患者用药以来血钙变化情况。结果两组患者治疗4、12周腰椎骨密度[观察组:(1177±58)mg/cm2,(1229±75)mg/cm2比(1134±68)mg/cm2;对照组:(1152±52)mg/cm2,(1170±71)mg/cm2比(1141±74)mg/cm2]、SOC[观察组:(6.3±1.4)μg/L、(9.8±2.2)μg/L比(4.8±0.9)μg/L;对照组:(6.3±1.4)μg/L、(9.8±2.2)μg/L比(4.8±0.9)μg/L]均高于治疗前;观察组患者治疗2、3及4周后的血清钙均高于对照组且较治疗前升高[观察组:(2.56±0.45)mmol/L,(2.59±0.47)mmol/L,(2.62±0.43)mmol/L比(2.31±0.73)mmol/L;对照组:(3.39±0.34)mmol/L,(2.41±0.40)mmol/L,(2.44±0.38)mmol/L比(2.35±0.58)mmol/L],观察组腰椎骨密度、SOC、血清钙上升速度更快,两组在组间、不同时点间、组间·不同时点间交互作用比较差异有统计学意义(P<0.05);治疗4周及12周后观察组患者的梭形骨痂形成率高于对照组[57.14%(28/49)比95.92%(47/49),34.69%(17/49)比83.67%(41/49)],治疗4周及12周后观察组患者局部压痛率及治疗12周后观察组患者纵向叩击痛率低于对照组[75.51%(37/49)比91.84%(45/49),18.37%(9/49)比53.06%(26/49);14.29%(7/49)比36.73%(18/49)](P<0.05);治疗4周及12周后两组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论依降钙素联合及阿法骨化醇可提高患者腰椎骨密度,促进骨痂的早日形成,对骨折的愈合有明显的促进作用,且无明显不良反应。
Objective To explore the bone-healing promoting effect of elcatonin and alfacalcidol to the patients with fracture. Methods From Mar. 2014 to Mar. 2015,98 patients with humeral shaft fractureadmitted to Yibin Second People＇s Hospital for surgical treatment were included in the study and divided into an observation group and a control group according to the lottery method,49 cases each. The control group was given D3 calcium carbonate tablets,routine care and timely exercise after surgery; and the observation group was added with elcatonin 5 U / time,1 time / week and alfacalcidol 0. 5 μg / d,and gradually increased by the speed of 0. 25 μg / d till1 μg / d as maintenance dosage on the basis of the control group＇ s treatment.The bone mineral density of lumbar spine,serum osteocalcin,fracture healing and adverse reactions of the two groups were detected before treatment,4 weeks and 12 weeks after treatment. The changes of calcium of blood were recorded since medication every week. Results The lumbar spine BMD[observation group：（ 1177 ±58） mg / cm2,（ 1229 ±75） mg/cm2vs（ 1134 ± 68） mg / cm2; control group：（ 1152 ± 52） mg/cm2,（ 1170 ±71） mg / cm2vs（ 1141 ± 74） mg / cm2],the serum osteocalcin（ SOC） [observation group：（ 6. 3 ± 1. 4） μg/L,（ 9. 8 ±2. 2） μg/L vs（ 4. 8 ±0. 9） μg/L; control group：（ 6. 3 ± 1. 4） μg/L,（ 9. 8 ± 2. 2） μg/L vs（ 4. 8 ±0. 9） μg / L] after 4 weeks and 12 weeks of treatment were higher than before the treatment; the serum calcium 2 weeks,3 weeks and 4 weeks after treatment of the observation group were higher than the control group and before treatment[observation group：（ 2. 56 ± 0. 45） mmol / L,（ 2. 59 ± 0. 47） mmol / L,（ 2. 62 ± 0. 43）mmol / L vs（ 2. 31 ± 0. 73） mmol / L; control group：（ 3. 39 ± 0. 34） mmol / L,（ 2. 41 ± 0. 40） mmol / L,（ 2. 44 ± 0. 38） mmol/L vs（ 2. 35 ± 0. 58） mmol/L],the lumbar spine BMD,SDC,serum calcium of the observation group increased faster,the differences between groups,time points,groups time points interaction were statistically significant（ P〈0. 05）; the number of cases of fusiform callus of the observation group after4 weeks and 12 weeks of treatment were higher than the control group[57. 14%（ 28 /49） vs 95. 92%（ 47 /49）,34. 69%（ 17 /49） vs 83. 67%（ 41 /49） ],the number of cases of local tenderness of the observation group after 4 weeks and 12 weeks and the number of vertical percussion pain of the observation group after 12 weeks of treatment were lower than the control group [75. 51%（ 37 /49） vs 91. 84%（ 45 /49）,18. 37%（ 9 /49） vs 53. 06%（ 26 /49）; 14. 29%（ 7 /49） vs 36. 73%（ 18 /49） ]（ P〈0. 05）. There was no statistically significant of adverse reactions between the two groups after 4 weeks and 12 weeks of treatment（ P〉0. 05）.Conclusion Elcatonin and alfacalcidol can improve lumbar spine bone mineral density and promote early formation of callus,which plays an important role in promoting fracture healing without significant adverse reactions.
出处
《医学综述》
2016年第11期2240-2243,共4页
Medical Recapitulate
