股骨近端防旋髓内钉联合抗骨质疏松药物治疗高龄患者股骨转子间骨折的效果观察

Therapeutic effects of proximal femoral nail antirotation combined with anti-osteoporosis drugs on elderly patients with femoral intertrochanteric fractures

目的 分析股骨近端防旋髓内钉(PFNA)联合抗骨质疏松药物治疗高龄患者股骨转子间骨折的临床效果.方法 选取2017年7月至2019年6月在寿光市人民医院治疗的高龄股骨转子间骨折患者70例,采用随机数字表法将其分为对照组35例和观察组35例.观察组采取PFNA术且围术期加用抗骨质疏松药物治疗,对照组仅予以PFNA治疗.记录并比较两组手术情况、并发症发生情况及预后情况.结果 两组手术时间、术中出血量、术后住院时间比较差异未见统计学意义(P>0.05);观察组并发症发生率[5.71%(2/35)]与对照组[8.57%(3/35)]比较,差异未见统计学意义(P>0.05);两组骨痂出现时间、骨折愈合时间比较差异未见统计学意义(P>0.05);治疗前,两组股骨颈骨密度、Harris量表评分情况比较差异未见统计学意义(P>0.05);随访6个月,观察组Harris量表评分提高幅度优于对照组(P<0.05);观察组股骨颈骨密度较治疗前提高(P<0.05),对照组该指标治疗前后比较差异未见统计学意义(P>0.05);观察组随访期间再骨折发生率[11.43%(4/35)]低于对照组[28.57%(10/35)],差异有统计学意义(P<0.05).结论 对股骨转子间骨折的高龄患者采取PFNA+抗骨质疏松药物治疗,其近、远期疗效均较优,有利于保障患者预后.

Objective To analyze the effects of proximal femoral nail antirotation(PFNA)combined with anti-osteoporosis drugs on elderly patients with intertrochanteric fractures.Methods Seventy elderly patients with femoral intertrochanteric fractures treated in Shouguang People’s Hospital from July 2017 to June 2019 were enrolled in the study.They were divided into control group(35 patients)and observation group(35 patients)by random number table menthod.In the observation group,patients with femoral intertrochanteric fractures were treated by PFNA surgery combined with anti-osteoporosis drugs in perioperative period;while patients in the control group were only treated by PFNA.The operation,complications and prognoses of the two groups were recorded and compared.Results There was no significant difference in the operation time,intraoperative blood loss or postoperative hospital stay between the two groups(P>0.05).The incidence of complications was 5.71%(2/35)in the observation group and 8.57%(3/35)in the control group,and the difference in the index between the two groups was not significant(P>0.05).There was no significant difference in callus appearance time or fracture healing time between the two groups(P>0.05).Before treatment,there was no significant difference between the two groups in bone mineral density,femoral neck or Harris scale score(P>0.05).After 6 months of follow-up,the improvement of Harris scale score in the observation group was better than that in the control group(P<0.05);the bone mineral density of the femoral neck in the observation group was significantly higher than preoperative density(P<0.05),but there was no significant change in bone minteral density in the control group(P>0.05).The incidence of re-fracture in the observation group was 11.43%(4/35),lower than the 28.57%(10/35)in the control group,and the difference was statistically significant(P<0.05).Conclusions The treatment of PFNA combined with anti-osteoporosis drugs in elderly patients with intertrochanteric fractures is superior in the short-term and long-term effects,which is conductive to ensuring the prognosis of patients.