低频脉冲电磁场联合唑来膦酸对骨质疏松性股骨粗隆骨折术后的影响

Effect of low frequency pulsed electromagnetic field combined with zoledronic acid on postoperative osteoporotic femoral osteotomy

目的探索低频脉冲电磁场(low frequency pulsed electromagnetic field,LFPEF)联合唑来膦酸对骨质疏松性股骨粗隆骨折术后的影响。方法 2013年4月至2016年4月收治的老年骨质疏松性股骨粗隆骨折128例,随机将其分为治疗组和对照组,每组64例,两组患者均接受防旋股骨近端髓内钉(proximal femoral nail anti-rotation,PFNA)治疗。对照组术后给予唑来膦酸治疗,治疗患者术后给予唑来膦酸联合LFPEF治疗,比较两组患者治疗后患者视觉模拟痛疼评分(visual analogue score,VAS)和髋关节Harris功能评分、骨折愈合时间、股骨颈及腰椎的骨密度、骨代谢指标的改变以及治疗期间的不良反应。结果术后1个月、3个月、6个月两组患者VAS评分均明显降低,且治疗组患者评分明显低于对照组(P<0.05);术后3个月、6个月两组患者的Harris评分均明显上升,且治疗组患者评分明显高于对照组(P<0.05);治疗组骨折愈合的时间明显少于对照组(P<0.05);术后6个月两组患者股骨颈及腰椎的骨密度,治疗组较治疗前改善更为明显(P<0.05)。两组患者血清I型胶原交联羧基末端肽和抗酒石酸酸性磷酸酶-5b水平均较治疗前显著降低(P<0.05),治疗组下降更为明显。而两组治疗期间出现不良反应比较差异无统计学意义(P>0.05)。结论 LFPEF联合唑来膦酸是一种安全有效的辅助治疗老年骨质疏松粗隆骨折的方法。

Objective To investigate the effect of low frequency pulsed electromagnetic field（LFPEF） combined with zoledronic acid on postoperative osteoporotic femoral osteotomy. Methods From April 2013 to April 2016,128 cases of osteoporotic femoral osteotomy were randomly divided into treatment group and control group. Both groups received proximal femoral nail anti-rotation（PFNA） treatment. The patients in the control group were treated with zoledronic acid and in the treatment group treated with zoledronic acid in combination with LFPEF after surgery. Visual analogue pain scores（VAS）,hip function scores（Harris）,fracture healing time,bone density of femoral neck and lumbar spine,bone metabolism and adverse reactions during treatment were compared between the two groups. Results The VAS scores of the two groups were significantly lower at 1,3 and 6 months after operation,and scores of the treatment group were lower than those of the control group（P 〈 0. 05）. The Harris scores of the two groups were significantly higher at 3 and 6 months after operation,and the scores of the treatment group were significantly higher than those of the control group（P 〈 0. 05）. The time of fracture healing in the treatment group was significantly lower than that in the control group（P 〈 0. 05）. The bone mineral density of femoral neck and lumbar vertebrae had greater improvement in the treatment group than in the control group at 6 months（P 〈 0. 05）. The levels of CTX-I and TRACP-5 b were significantly lower in the two groups compared with pre-operation（P 〈 0. 05）,and the decrease in the treatment group was greater. There were no significant differences in the adverse reactions between the two groups（P 〉 0. 05）. Conclusion LFPEF combined with zoledronic acid is a safe and effective method for the treatment of osteoporosis in elderly patients.