LISS结合唑来膦酸治疗股骨近端防旋髓内钉术后Vancouver C型骨折的疗效观察

Efficacy of percutaneous LISS combined with zoledronic acid in the treatment of Vancouver type C fracture after PFNA treatment of intertrochanteric fractures

目的:探讨微创内固定系统(LISS)结合唑来膦酸治疗股骨粗隆间骨折经股骨近端防旋髓内钉(PFNA)术后发生的Vancouver C型骨折的临床疗效。方法:回顾性分析2017年6月至2019年4月我院收治的26例股骨粗隆间骨折PFNA术后Vancouver C型骨折患者的临床资料。按照治疗方式分为观察组(14例,经皮LISS结合唑来膦酸)和对照组(12例,单纯经皮LISS)。评估2组患者下床活动时间(术后卧床至初次进行床下活动时间)、骨折愈合时间,术后1年血清钙、碱性磷酸酶浓度,术后1年2组患者股骨近端骨密度(bone mineral density,BMD)、VAS评分及膝关节功能评分(Hospital for Special Surgery,HSS)及并发症发生情况。结果:观察组患者下床活动时间和骨折愈合时间均明显低于对照组(P<0.05)。术后1年,观察组VAS评分低于对照组(P<0.05),HSS评分高于对照组(P<0.05),血清钙和碱性磷酸酶浓度明显低于对照组(P<0.05),BMD高于对照组(P<0.05);2组患者并发症情况相比较,差异无统计学意义(P>0.05)。结论:经皮LISS结合唑来膦酸治疗股骨粗隆间骨折PFNA术后Vancouver C型骨折能够有效促进骨折愈合,抑制骨量丢失,具有临床指导价值。

Objective:To investigate the clinical efficacy of percutaneous less invasive stabilization system(LISS)combined with zoledronic acid in the treatment of Vancouver type C fracture after proximal femoral nail anti-rotation(PFNA)treatment of intertrochanteric fractures.Methods:From Jun 2017 to Apr 2019,26 patients with Vancouver type C fracture treated in our hospital after PFNA were enrolled.According to the treatment methods,they were divided into observation group(14 cases,percutaneous LISS combined with zoledronic acid)and control group(12 cases,percutaneous LISS alone).The time of getting out of bed,fracture healing time,and serum calcium and alkaline phosphatase concentrations,bone mineral density(BMD)of proximal femur,VAS score,score of hospital for special surgery(HSS)and the occurrence of complications at 1 year after surgery were evaluated.Results:The time of getting out of bed and healing time of fracture in observation group were significantly lower than those in control group(P<0.05).At 1 year after surgery,the VAS score of the observation group was lower than that of the control group(P<0.05).The knee joint HSS score in the observation group was higher than that in the control group(P<0.05).The postoperative serum calcium and alkaline phosphatase in the observation group were significantly lower than those in the control group(P<0.05).BMD in the observation group was higher than that in the control group(P<0.05).There was no significant difference in complications between the two groups(P>0.05).Conclusion:Percutaneous LISS combined with zoledronic acid in the treatment of Vancouver type C fracture after PFNA treatment of intertrochanteric fractures can effectively promote fracture healing and inhibit bone loss,which has clinical guidance value.