序贯抗骨质疏松对老年股骨粗隆间骨折愈合时间及再骨折的影响

The Effect of Sequential Anti-osteoporosis on the Healing Time of Intertrochanteric Fracture and Re-fracture in the Elderly

目的探讨序贯抗骨质疏松治疗对老年骨质疏松性股骨粗隆间骨折愈合时间及再骨折的影响。方法选取我院2017年11月-2018年9月收治的120例老年股骨粗隆间骨折行PFNA手术患者作为研究对象,按照随机数字法分为对照组、降钙素组及序贯疗法组,各40例。对照组行PFNA治疗,补充钙剂、活性维生素D,降钙素组在对照组的基础上给予鲑鱼降钙素治疗,序贯组在降钙素疗程结束后静滴唑来膦酸序贯治疗。比较三组VAS评分、Harris评分、骨折愈合时间、骨密度、骨代谢指标[血清Ⅰ型前胶原氨基末端前肽(PINP)、Ⅰ型胶原蛋白交联羧基末端肽(β-CTX)]、并发症及其他部位再骨折情况。结果治疗后1、3及12个月,三组VAS评分、Harris评分较治疗前均改善,且降钙素组及序贯组较对照组的改善效果更好,差异均有统计学意义(P<0.05);治疗后12个月,序贯组VAS评分、Harris评分较降钙素组改善,差异有统计学意义(P<0.05);降钙素组及序贯组骨折愈合时间短于对照组,差异有统计学意义(P<0.05);治疗12个月,降钙素组及序贯组骨密度和骨代谢指标均优于对照组,且序贯组优于降钙素组,差异有统计学意义(P<0.05);三组均未出现骨折延迟愈合及不愈合,但降钙素组及序贯组并发症及其他部位再骨折发生率高于对照组,差异有统计学意义(P<0.05)。结论降钙素联合唑来膦酸的序贯抗骨质疏松治疗老年骨质疏松性股骨粗隆间骨折疗效可靠,可有效提高患者骨密度,促进骨折愈合,降低再骨折的风险,安全性良好。

Objective To investigate the effect of sequential anti-osteoporosis treatment on the healing time and re-fracture of elderly osteoporotic femoral intertrochanteric fractures.Methods A total of 120 elderly patients with intertrochanteric fractures of the femur who underwent PFNA surgery,who were admitted to our hospital from November 2017 to September 2018,were selected as the research objects.They were divided into control group,calcitonin group and sequential therapy group according to the random number method.40 cases each.The control group was treated with PFNA,supplemented with calcium and active vitamin D,the calcitonin group was treated with salmon calcitonin on the basis of the control group,and the sequential group was treated with intravenous zoledronic acid after the end of the calcitonin course.Comparing the three groups of VAS score,Harris score,fracture healing time,bone density,bone metabolism indicators[serum type I procollagen amino terminal propeptide(PINP),type I collagen cross-linked carboxy terminal peptide(β-CTX)],complications and re-fractures in other parts.Results 1,3 and 12 months after treatment,the VAS scores and Harris scores of the three groups were improved compared with those before the treatment,and the calcitonin group and the sequential group had better improvement effects than the control group,the differences were statistically significant(P<0.05);12 months after treatment,the VAS score and Harris score of the sequential group were better than those of the calcitonin group,the difference was statistically significant(P<0.05);The fracture healing time of the calcitonin group and the sequential group was shorter than that of the control group,the difference was statistically significant(P<0.05);After 12 months of treatment,the bone mineral density and bone metabolism indexes of the calcitonin group and the sequential group were better than those of the control group,and the sequential group was better than the calcitonin group,the difference was statistically significant(P<0.05);There was no delayed fracture union or nonunion in the three groups,but the incidence of complications and re-fractures in other parts of the calcitonin group and the sequential group was higher than that of the control group,the difference was statistically significant(P<0.05).Conclusion The sequential anti-osteoporotic effect of calcitonin combined with zoledronic acid in the treatment of elderly osteoporotic intertrochanteric fractures is reliable.It can effectively increase the bone density of patients,promote fracture healing,reduce the risk of re-fracture,and has good safety.