阿仑膦酸钠对股骨转子间骨折PFNA术后疗效的临床影响

The clinical research of alendronate in treatment of osteoporotic femoral intertrochanteric fracture after PFNA

目的:探讨阿仑膦酸钠对老年骨质疏松性股骨转子间骨折PFNA术后疗效的影响.方法:以114例老年骨质疏松性股骨转子间骨折患者作为研究对象.阿仑膦酸钠组在PFNA手术的基础上给予口服阿仑膦酸钠片及碳酸钙D3片,对照组单纯给予PFNA手术及碳酸钙D3片.比较两组患者骨折愈合时间、髋关节Harris评分、术后1年骨矿密度、手术相关并发症及再发骨折情况.结果:阿仑膦酸钠组患者骨折愈合时间为(13.8±1.2)周,对照组为(14.3±1.1)周,两组愈合时间无统计学差异(P=0.204).术后12月,阿仑膦酸钠组患者患髋Harris评分为87.1±5.9,对照组为86.2±5.5,无统计学差异(P=0.514).术后1年阿仑膦酸钠组健髋骨矿密度为0.68±0.07,对照组为0.62±0.08,有统计学差异(P=0.007);阿仑膦酸钠组L2-4椎体骨矿密度高于对照组,有统计学差异(P=0.011).结论:股骨转子间骨折PFNA术后早期使用阿仑膦酸钠不会影响骨折愈合,长期服用阿仑膦酸钠可明显增加患者全身骨密度,但对改善患者患髋功能无帮助.

Objective： To investigate the effect of alendronate on osteoporotic femoral intertrochanteric fractures after PFNA in elderly patients. Methods： 114 patients with osteoporotic intertrochanteric fractures were enrolled in our hospital from November 2013 to December 2015. Alendronate sodium group conducted PFNA surgery,in addition to oral alendronate tablets and calcium carbonate D3 tablets,while the control group conducted PFNA surgery and oral calcium carbonate D3 tablets. The fracture healing time,hip joint Harris score,bone mineral density at 1 year postoperation,operative-related complications and recurrence fractures were compared between two groups. Results： The fracture healing time of alendronate sodium group was 13. 8 ± 1. 2 weeks and the control group was 14. 3 ± 1. 1 weeks.There was no significant difference in fracture healing time between two groups（ P = 0. 204）. At 12 months postoperation,the hip joint Harris was 87. 1 ± 5. 9 in alendronate sodium group and 86. 2 ± 5. 5 in control group, the difference was not statistically significant（ P = 0. 514）. At 12 months postoperation,the bone mineral density of healthy hip joint was 0. 68 ± 0. 07 in alendronate sodium group and 0. 62 ± 0. 08 in control group,the difference was statistically significant（ P = 0. 007）. The bone mineral density of L2-4 vertebral body in alendronate sodium group was higher than that in control group（ P = 0. 011）. Conclusion： Early use of alendronate sodium after PFNA in femoral intertrochanteric fracture had little influence on fracture healing,the long-term use of alendronate sodium was helpful to increase bone mineral density,but it is helpless to improve the hip joint function.