股骨近端防旋髓内钉联合唑来膦酸治疗骨质疏松性转子间骨折的疗效观察

Clinical outcomes of the proximal femoral nail antirotation combined with zoledronic acid for elderly osteoporotic intertrochanteric fractures

背景:股骨近端防旋髓内钉(PFNA)是转子间骨折的有效治疗方法之一,但骨量较低的患者术后易产生螺旋刀片切出、髋内翻等并发症。目的:探究PFNA联合唑来膦酸治疗骨质疏松性转子间骨折的有效性和安全性。方法:2011年8月至2014年9月采用PFNA治疗200例骨质疏松性转子间骨折患者,依据抗骨质疏松手段的不同随机将患者分为治疗组和对照组,治疗组采用唑来膦酸进行抗骨质疏松症治疗;对照组采用传统抗骨质疏松症治疗。两组患者的一般资料具有可比性,记录两组患者住院时间、骨折愈合时间、术后1年髋部和椎体骨密度、髋关节功能评分(Harris评分)、髋关节功能优良率、髋部VAS评分、术后并发症等。结果:两组患者平均住院时间、骨折愈合时间、Harris评分、髋关节功能优良率、髋部VAS评分均无统计学差异(P>0.05)。治疗组术后1年腰椎骨密度和髋部骨密度明显高于对照组(P<0.05);治疗组术后并发症率为8%,明显低于对照组的19%(P<0.05)。结论:PFNA联合唑来膦酸能有效提高骨质疏松性转子间骨折患者的骨密度,降低术后并发症的发生率,安全性较高,值得临床推广。

Background：Proximal femoral nail anti-rotation （PFNA） internal fixation is one of the effective treatments for intertrochanteric fractures. But some complications, such as postoperative spiral blade incision and hip varus may occur in patients with low bone mass. Objective：To explore the efficacy and safety of PFNA combined with zoledronic acid in elderly osteoporotic intertrochanteric fractures. Methods：A total of 200 patients with osteoporotic intertrochanteric fracture treated by PFNA internal fixation between August 2011 and September 2014 were enrolled in this study. They were randomly divided into treatment group and control group according to different anti-osteoporosis treatments. General information of the two groups were comparable. The hospitalization time, fracture healing time, bone mineral density （BMD） of hip and lumbar, hip function outcome （Harris score）, good rate of hip function, hip VAS score and postoperative complications were recorded and evaluated. Results：There were no significant differences in the hospitalization time, fracture healing time, Harris score, good rate of hip function, or hip VAS score between two groups （P〉0.05）. Hip and lumbar BMD in treatment group were significantly higher than those in control group （P〈0.05） one year after treatment. The rate of postoperative complica-tions in treatment group was significantly lower than that in control group （8%vs 19%, P〈0.05）. Conclusions：PFNA combined with zoledronic acid can effectively improve BMD and reduce postoperative complications in treatment of osteoporotic intertrochanteric fractures.