胰岛素在2型糖尿病患者股骨转子间骨折治疗中的作用

Role of insulin in treatment of femoral intertrochanteric fracture in patients with type 2 diabetes mellitus

目的探讨胰岛素在2型糖尿病患者股骨转子间骨折治疗中的作用。方法选择2012年1月—2014年6月于上海交通大学医学院附属新华医院崇明分院30例首次诊断为2型糖尿病的股骨转子间骨折患者,年龄58~82岁,根据是否进行胰岛素治疗,将其随机分为胰岛素组和非胰岛素组,每组15例。术后3个月内每2周门诊随访1次,3个月至1年内每3个月门诊随访1次,1年后每半年门诊随访1次。观察并比较两组患者的术前准备时间、临床愈合时间、扶拐下地时间,术后2个月的骨密度指标(L1、股骨颈、华氏三角区各点骨密度)、骨代谢指标(血钙、骨钙素),术后并发症发生情况和髋关节Harris评分。结果胰岛素组的术前准备时间、临床愈合时间和扶拐下地时间均显著短于非胰岛素组(P值均<0.05);胰岛素组术后2个月的L1、股骨颈、华氏三角区各点骨密度,以及骨钙素水平均显著高于非胰岛素组(P值均<0.05);两组间血钙水平的差异无统计学意义(P>0.05)。30例患者均获随访,随访时间12~20个月,平均为(18.8±5.6)个月。两组术后均无防旋刀片切出股骨头,无髋内翻畸形愈合,无股骨头坏死,无刀片、主钉断裂发生。两组间术后3、6、12个月的髋关节Harris评分的差异均无统计学意义(P值均>0.05)。结论对于2型糖尿病合并股骨转子间骨折行手术治疗的老年患者,胰岛素干预治疗可有效缩短术前准备时间,促进骨折的愈合,且可增强骨强度,但仍需结合其他抗骨质疏松治疗,疗效才能更佳。

Objective To investigate the effect of insulin on femoral intertrochanteric fracture healing in patients with type 2 diabetes mellitus （T2DM）. Methods Thirty patients who suffered from femoral intertrochanteric fractures and were diagnosed as T2DM for the first time and treated surgically in our hospital between January 2012 and June 2014 were enrolled in this study. They aged from 58 to 82 years old. According to the different diabetic treatment therapies （oral medications or insulin injection）, the patients were randomly divided into insulin group and non-insulin group （n= 15）. They were followed up every two weeks in the first three months postoperatively, every three months between 3 and 12 months postoperatively, and then every six months; Preoperative preparation time, clinical healing time, early functional exercise time, bone mineral density （L,, femoral neck, the bone density of the Fahrenheit triangle） and bone metabolism indexes （calcium, osteocalcin） at 2 months after operation, postoperative complications and Harris score of hip joint were compared between two groups. Results Preoperative preparation time, clinical healing time and early functional exercise time in the insulin group were significantly shorter than those in the non-insulin group （all P〈0. 05）. L,, femoral neck, the bone density .of the Fahrenheit triangle and osteocalcin at 2 months after operation in the insulin group were significantly higher than those in the non-insulin group （all P^0.05）. There were no significant differences in the serum calcium level or Harris score between groups （all P^0.05）. The mean duration of follow-up was （ 18.8±5.6） months （range, 12-20 months） in all the patients. No malunion, osteonecrosis of the femoral head or breakage occurred. Conclusion insulin can .effectively shorten preoperative preparation time, promote the healing of fracture, and strengthen bone strength in senile T2DM patients with femoral intertrochanteric fractures, Moreover, it is essential to receive anti-osteoporosis treatment so as to achieve better therapeutic effect.