唑来膦酸对老年股骨粗隆间骨折患者PFNA术后早期的影响

目的探讨股骨近端防旋髓内钉(PFNA)术后一次给予唑来膦酸对老年股骨粗隆间骨折患者早期的影响。方法2018年1月至2019年12月PFNA治疗的老年骨质疏松性股骨粗隆间骨折患者40例,随机分为观察组与对照组。观察组:PFNA术后第1周内予静脉滴注唑来膦酸5 mg/100 mL。对照组:相同剂量的0.9%氯化钠溶液滴注。两组术后口服钙剂1,200 mg/d和活性维生素D3800IU/d。在治疗的不同时期评估两组疼痛评分(NRS)、骨密度(BMD)、骨代谢指标、内固定失效率、完全负重时间、Harris评分。结果观察组术后2周、6周翻身痛改善优于对照组,观察组术后3个月、6个月骨吸收代谢指标比对照组明显下降,差异均有统计学意义(P<0.05)。观察组术后6个月骨密度值、内固定失效率、Harris评分均优于对照组,差异均有统计学意义(P<0.05)。观察组术后完全负重时间早于对照组,差异有统计学意义(P<0.05)。结论PFNA术后一次给予唑来膦酸可以在早期减轻术后疼痛,降低骨吸收,降低内固定失效率,加快完全负重时间及改善术后髋关节功能。

Objective To observe the effect of zoledronic acid on elderly patients with intertrochanteric fracture in early period after proximal femoral intramedullary fixation(PFNA)surgery.Methods From June 2018 to December 2020,a total of 40 patients with senile osteoporotic femoral intertrochanteric fracture,who accepted PFNA under anesthesia were analyzed.The patients were randomly divided into two groups.The treatment group(20 cases)were received one 100 mL/5 mg of zoledronic acid injection in the first week after the operation,and the control group(20 cases)were given the same volume of normal saline(NS)injection in the first week after the operation.Both groups were orally taken 1200 mg/d of calcium carbonate and active vitamin D3800 IU/d daily after the surgery.Pain numerical rating scale(NRS),bone mineral density(BMD),indexes of bone metabolism,time to resume complete weight-bearing activity and Harris score were evaluated in during different periods of medication.Results Compared with the control group,pain of posture changing were significantly alleviated(P<0.05),and indexes of bone metabolism were significantly brought down in the treatment group after 2 weeks and 6 weeks of medication,and the bone resorption metabolic index in the treatment group was significantly lower than that in the control group at 3 and 6 months after operation,and the differences were statistically significant(all P<0.05).The treatment group performed superior to control group in improving bone density,internal fixation fail rate,Harris score after 6 months,and the differences were statistically significant(all P<0.05).The treatment group were significantly earlier than the control group in time to resume complete weight-bearing activity,with statistical significance(P<0.05).Conclusion The injection of zoledronic acid in elderly patients with intertrochanteric fracture can effectively decrease acute bone loss,reduce the occurrence of internal fixation fail,improve hip joint function,enhance time to weight-bearing activity and relieve the pain from osteoporotic fracture in early period PFNA surgery.