术后不同时间应用双膦酸盐对骨质疏松性转子间骨折愈合的影响

Effect of bisphosphonate administration on bone union in osteoporotic intertrochanteric fracture at different time points after operation

目的探讨术后不同时间应用双膦酸盐对骨质疏松性转子间骨折愈合的影响。方法回顾性分析我院2009年1月至2014年10月收治的346例骨质疏松性转子间骨折病人的临床资料。根据术后应用双膦酸盐类药物的时间不同分为1周组(术后1周内开始用药,158例)、1月组(术后1周至1个月内开始用药,86例)和3月组(术后1~3个月内开始用药,102例)。对比分析三组病人的骨折愈合情况、平均愈合时间、Harris髋关节评分、手术前后腰椎(L1~4)骨密度值变化及术后并发症情况等。结果 1周组、1月组和3月组的骨折正常愈合的比例(91.77%、91.86%和95.10%)、平均骨折愈合时间[(14.68±3.04)周、(15.22±2.46)周、(14.54±2.88)周]、髋关节Harris评分[(88.27±12.94)分、(86.36±13.16)分、(87.69±11.98)分]比较,差异均无统计学意义(P均>0.05)。术后3、6个月时,3月组的腰椎骨密度值[(0.7187±0.1084)g/cm^2、(0.7604±0.1225)g/cm^2]均低于1周组[(0.7606±0.0855)g/cm^2、(0.8027±0.1090)g/cm^2]和1月组[(0.7533±0.1103)g/cm^2、(0.7961±0.0881)g/cm^2],差异均有统计学意义(P均<0.05);1周组腰椎骨密度值在术后3个月时即显著高于术前,而1月组、3月组则在术后6个月时才较前一次有明显升高。三组病人胃肠道反应、发热、肌肉或关节疼痛、再发骨折、内固定松动或移位、内固定感染、断钉等术后并发症的差异没有统计学意义(P均>0.05)。结论骨质疏松性转子间骨折术后不同时间应用双膦酸盐类药物不影响骨折的愈合,而术后早期应用双膦酸盐类药物可以更快地提升病人的骨密度。

Objective To investigate the effect of bisphosphonate administration on the bone union in osteoporotic intertrochanteric fracture at different time points after operation.Methods The clinical data of346patients with osteoporotic intertrochanteric fractures,from January2009to October2014,were analyzed retrospectively.The patients were divided into three groups according to the time of bisphosphonate administration after operation:within one week(one week group,158cases),after one week to less than one month(one month group,86cases),and after one month to three months(three month group,102cases).The average healing time,Harris hip score,changes of preoperative and postoperative lumbar(L1?4)bone mineral density(BMD)and postoperative complications,etc.were compared among the three groups.Results For the one week group,one month group and three month group,the normal fracture healing ratio(91.77%,91.86%and95.10%),the average healing time[(14.68±3.04),(15.22±2.46)and(14.54±2.88)weeks],Harris hip score(88.27±12.94,86.36±13.16and87.69±11.98)showed no statistically significant difference(P>0.05).The lumbar BMD in the three month group at3rd and6th month after operation[(0.7187±0.1084)and(0.7604±0.1225)g/cm2]was significantly lower than that in the one week group[(0.7606±0.0855)and(0.8027±0.1090)g/cm2]and the one month group[(0.7533±0.1103)and(0.7961±0.0881)g/cm2](P<0.05).The lumbar BMD in the one week group at3rd month after the operation was higher than that before operation(P<0.05),and the lumbar BMD in the one month group and three month group at6th month was just elevated significantly(P<0.05).There was no significant difference in complications among the three groups,including gastrointestinal reactions,fever,muscle or joint pain,recurrent fracture,internal fixation loosening or displacement,internal fixation infection,broken nail(P>0.05).Conclusion The initiating time of bisphosphonate administration following surgery did not affect the bone union in patients with osteoporotic intertrochanteric fracture,but the early use of bisphosphonates after operation can improve BMD rapidly.