不同手术方式对老年骨质疏松性股骨颈骨折病人骨密度及骨代谢的影响

Effect of different surgical methods on perioperative BMD and bone metabolism in elderly patients with osteoporotic hip fracture

目的探讨人工股骨头置换术与全髋关节置换术对老年骨质疏松性股骨颈骨折病人围手术期骨密度及骨代谢的影响。方法老年骨质疏松性股骨颈骨折病人95例,根据手术方式不同分为对照组与观察组。对照组采取人工股骨头置换术,观察组采取全髋关节置换术,比较其骨密度及骨代谢指标。结果术后4个月,对照组腰椎骨密度为(829.71±21.45)mg/cm^3,Wards三角区为(826.52±19.87)mg/cm^3,股骨颈为(794.26±27.25)mg/cm^3,观察组分别为(848.52±22.32)mg/cm^3、(849.57±21.98)mg/cm^3和(815.23±28.64)mg/cm^3,两组比较差异有统计学意义(P<0.05)。对照组的血清骨钙素蛋白(BGP)为(3.14±0.27)ng/ml,骨碱性磷酸酶(ALP)为(73.26±7.07)U/L,骨碱性磷酸酶(BALP)为(71.71±1.07)U/L,骨抗酒石酸酸性磷酸酶(TRACP-5b)为(3.26±1.07)U/L,观察组分别为(3.61±0.56)ng/ml、(69.94±7.67)U/L、(76.61±1.16)U/L和(3.94±1.61)U/L,两组比较差异有统计学意义(P<0.05)。对照组并发症发生率为10.8%,观察组为14.3%,两组比较差异有统计学意义(P<0.05)。结论人工股骨头置换术与全髋关节置换术对治疗老年骨质疏松性股骨颈骨折病人具有不同的临床疗效,全髋关节置换术能更好的改善骨密度及骨代谢指标,但具有较高的术后并发症。

Objective To investigate the effects of artificial femoral head replacement and total hip arthroplasty on the bone mineral density and bone metabolism during the perioperative period in elderly patients with osteoporotic hip fracture.Methods The clinical data of 95 patients with senile osteoporotic hip fracture were retrospectively analyzed.The patients were divided into control group and observation group according to different surgical methods.Artificial femoral head replacement was performed in the control group,and total hip replacement was performed in the observation group.The perioperative bone mineral density and bone metabolism index were compared.Results The bone density of the control group was(829.71±21.45)mg/cm^3,Wards triangle area was(826.52±19.87)mg/cm^3 and femoral neck was(794.26±27.25)mg/cm^3.The bone density of the patients in the observation group was(848.52±22.32)mg/cm^3,Wards triangle area(849.57±21.98)mg/cm^3,femoral neck(815.23±28.64)mg/cm^3.The difference of degree was statistically significant(P<0.05).The patients in the control group were BGP(3.14±0.27)ng/mL,ALP(73.26±7.07)U/L,BALP(71.71±1.07)U/L,TRACP5 b(3.26±1.07)U/L,in the observation group was(3.61±0.56)ng/mL,(69.94±7.67)U/L,(76.61±1.16)U/L and(3.94±1.61)U/L.The difference was statistically significant(P<0.05).The incidence of complications in the control group was 10.8%The incidence of complications in the observation group was 14.3%.There was significant difference between the two groups in the incidence of complications(P<0.05).Conclusion Artificial femoral head replacement and total hip arthroplasty have different clinical effects in the treatment of elderly patients with osteoporotic hip fracture.Total hip arthroplasty can improve bone mineral density and bone metabolism better,but with higher Postoperative complications.