抗骨质疏松治疗在老年粗隆间骨折股骨近端防旋髓内钉术后病人中的应用

doi:10.3969/j.issn.1005-6483.2019.05.024

摘要/Abstract

摘要： 目的:探讨抗骨质疏松治疗在老年粗隆间骨折病人术后治疗中的意义。方法:粗隆骨折且行股骨近端防旋髓内钉（PFNA）治疗的老年病人58例，使用不透明信封法随机分为抗骨质疏松治疗组（A组）28例和非抗骨质疏松治疗组（B组）30例。记录病人的一般情况。A组病人术后后给予抗骨质疏松治疗，B组则不给予。开展随访，定期复查X线片，记录骨折愈合时间，全身其他部位骨折发生情况，以及深部感染、髋内翻、内固定物切割、内固定物周围骨折、内固定失败等并发症发生情况，并于术后6个月、术后12个月对髋关节功能进行Harris评分和病人患侧大转子骨密度检测。结果:所有病例均获随访。A组骨折愈合时间为（12.1±2.9）周，B组为（12.8±3.3）周，组间比较差异无统计学意义（P>0.05）。两组均未发生深部感染、髋内翻、内固定物切割、内固定物周围骨折、内固定失败等并发症。随访期限内，A组未发生患肢及其他部位的再骨折，B组发生2例桡骨远端骨折和1例胸椎压缩性骨折，组间比较差异无统计学意义（P>0.05）。术后6个月和术后12个月，髋关节Harris评分A组分别为（87.3±14.6）和（95.8±15.4），均高于B组的（78.6±15.9）和（86.1±16.8），；A组病人骨密度分别为（0.74±0.05）和（0.81±0.09），B组分别为（0.66±0.08）和（0.71±0.10），差异有统计学意义（P<0.05）。结论:老年病人粗隆间骨折PFNA术后是否进行抗骨质疏松治疗，对骨折愈合时间无明显影响，并发症发生率无明显差异；但对于提高骨密度和改善髋关节功能方面有积极意义。

关键词: 骨质疏松, 粗隆间骨折, 股骨近端防旋髓内钉

Abstract: Objective:To investigate the efficacy of antiosteoporosis treatment on elderly patients with intertrochanteric fractureMethods:Elderly patients with intertrochanteric fracture treated with PFNA were randomly divided into antiosteoporosis treatment group（group A）and nonantiosteoporosis treatment group（group B）.The patient's general information was recorded.Patients in group A were given antiosteoporosis treatment after the operation.Patients in group B receive no antiosteoporosis drugs.One year followup was carried out and several indicators were recorded，such as the fracture healing time，the occurrence of fractures in other parts of the body，the complications of deep infection，hip varus，internal fixation incision，internal fixation fracture and internal fixation failure.The hip function was evaluated by the Harris score system at 6 months and 1 year after surgery，while the bone density was tested by the United States Lunar DPXNP dualenergy xray absorptiometry.Results:All cases were followed up.The fracture healing time in group A was（12.1±2.9）weeks and in group B was（12.8±3.3）weeks.There was no significant difference between the two groups（P>0.05）.Neither deep infection nor hip varus，incision of internal fixation，fracture around internal fixation，internal fixation failure or other complications occurred in both groups.During the followup period，there was none refracture of limbs and other parts in group A，2 distal fractures of radius and 1 thoracolumbar fracture happened in group B（P>0.05）.The Harris score of hip joint in group A[87.3±14.6，95.8±15.4] at 6 months and 1 year after operation were significantly higher than in group B[78.6±15.9，86.1±16.8]（P<0.05）.Compared with the control group，the bone mineral density in group B[0.66±0.08，0.71±0.10] was significantly increased than group A[0.74±0.05，0.81±0.09]at 6 months and one year after surgery，the difference was statistically significant（P<0.05）.Conclusion:In elderly patients with intertrochantericfracture，the postoperative antiosteoporosis treatment didn’t promote the fracture healing significantly，but it made good sense in increasing bone mineral density and improving hip joint function.

Key words: osteoporosis, intertrochanteric fractures, proximal femoral nail antirotation

陈森, 方洪松, 金志辉, 彭昊. 抗骨质疏松治疗在老年粗隆间骨折股骨近端防旋髓内钉术后病人中的应用[J]. 临床外科杂志, 2019, 27(5): 433-435.

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