特立帕肽联合低频脉冲电磁场治疗老年股骨粗隆间骨折

Application of parathyroid hormone combined with low frequency pulse electromagnetic field in elderly patients with intertrochanteric fracture

目的探讨老年患者股骨粗隆间骨折术后联合应用甲状旁腺素(PTH)类似物特立帕肽与低频脉冲电磁场(LFPEF)的临床效果。方法回顾性分析2016年5月~2018年5月我院收治的接受股骨近端防旋髓内钉(PFNA)手术治疗的老年股骨粗隆间骨折的患者48例,按治疗方法的不同将其分为对照组(n=24)和观察组(n=24)。对照组在术后给予PTH治疗,观察组在术后给予PTH联合LFPEF治疗。比较两组在治疗前、治疗3个月后、治疗6个月后的髋关节功能、骨痂愈合情况,以及两组患者治疗6个月后骨代谢生化指标、腰椎(L 1-4)、股骨大粗隆、股骨颈骨密度(BMD)。组间比较使用独立样本t检验,组内比较使用配对样本t检验或重复测量方差分析,计数资料比较采用卡方检验。结果与治疗前比较,两组患者治疗3个月后、治疗6个月后的Harris评分、Fernadez-esteve评分均升高(P<0.05),且观察组高于对照组(P<0.05)。与治疗前比,两组在治疗6个月后的BGP、BALP、PICP水平和腰椎(L 1-4)、股骨大粗隆、股骨颈BMD均升高(P<0.05),且观察组高于对照组(P<0.05)。结论PTH联合LFPEF可以改善老年股骨粗隆间骨折PFNA术后的髋关节功能,促进骨折的愈合,增加其BMD,值得临床推广应用。

Objective To investigate the effect of parathyroid hormone(PTH)mimicker teriparatide acetate combined with low frequency pulse electromagnetic field(LFPEF)on hip function and fracture healing in elderly osteoporosis patients with intertrochanteric fracture after PFNA.Methods Forty-eight elderly patients with femoral intertrochanteric fracture treated by PFNA in our hospital from May 2016 to May 2018 were randomly divided into control group(n=24)and observation group(n=24)according to different treatment methods.The control group was treated with PTH after operation,while the observation group was treated with PTH combined with LFPEF after operation.The hip joint function,fracture healing,biochemical indexes of bone metabolism and bone mineral density of lumbar spine(L 1-4),trochanter femoris and femoral neck were compared between the two groups before treatment,three and six months after treatment.Independent-t test was used to compare the measurement data between two groups,and chi-square test was used for enumeration data.Paired-t test and the repetitive measure analysis of variance for repeated measures were used to for intergroup compare.Results Compared with the results before treatment,the Harris score and Fernadez-esteve score of the observation group were higher than those of the control group after three and six months of treatment,(P<0.05),and the observation group was higher than the control group(P<0.05).Similarly,the levels of BGP,BALP,PICP,lumbar spine(L 1-4),trochanter femoris and femoral neck bone mineral density in the two groups increased after six months of treatment(P<0.05),and the observation group was higher than the control group(P<0.05).Conclusion PTH combined with LFPEF can improve hip joint function,increase bone mineral density and promote fracture healing in elderly patients with intertrochanteric fracture after PFNA,which is worthy of clinical application.