| 摘要: |
| 目的 评估股骨近端防旋转髓内钉（PFNA）内固定联合规范化抗骨质疏松药物治疗老年骨质疏松性股骨转子间骨折的临床疗效。方法 选取2012年6月-2014年6月采用PFNA治疗且获得完整随访资料的老年（≥60岁）股骨转子间骨折伴骨质疏松的患者，共78例，其中男性25例，女性53例。根据是否抗骨质疏松治疗将患者分为抗骨质疏松药物治疗组和对照组。治疗组共40例，除行PFNA治疗外，在补充钙剂、活性维生素D的基础上，给予鲑鱼降钙素、唑来膦酸盐序贯治疗；对照组共38例，单纯行PFNA治疗。术后观察骨折愈合情况，定期检测髋关节骨密度，采用Harris评分评价髋关节功能，记录药物不良反应及其他部位再骨折情况。结果 所有患者均顺利完成手术，未发生伤口感染、内固定失败等并发症。经X线片证实均能达到临床骨性愈合。两组骨折愈合时间及术后髋关节功能Harris评分差异无统计学意义。治疗组术后6个月、12个月和18个月时健侧髋关节骨密度高于对照组（P<0.05），且术后再发骨折发生率降低（P<0.05）。结论 PFNA治疗老年骨质疏松性股骨转子间骨折符合微创理念，操作简单，疗效满意。PFNA结合规范的抗骨质疏松药物治疗能增加骨密度，同时减少术后再骨折风险。 |
| 关键词: 股骨近端防旋转髓内钉 骨质疏松 股骨转子间骨折 降钙素 唑来膦酸 |
| DOI：10.16781/j.0258-879x.2017.04.0437 |
| 投稿时间：2016-12-20修订日期：2017-03-28 |
| 基金项目:湖北省自然科学基金（2014CKB1017）. |
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| Proximal femoral nail antirotation combined with normalized anti-osteoporosis drugs in treatment of elderly patients with osteoporotic femoral intertrochanteric fractures |
| GAO Fei,ZHOU Wu,XIE Mao,LIU Yi,ZHA Kun,LIU Guo-hui* |
(Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the clinical efficacy of proximal femoral nail antirotation (PFNA) internal fixtion combined with normalized anti-osteoporosis drugs in treating elderly patients with osteoporotic femoral intertrochanteric fractures. Methods Seventy-eight elderly osteoporosis patients (≥60 years old, 25 males and 53 females) with femoral intertrochanteric fractures were enrolled, who received PFNA operation from Jun. 2012 to Jun. 2014 and had complete follow-up data. Patients were divided into anti-osteoporosis treatment group and control group according to whether anti-osteoporosis treatment was given. Patients in anti-osteoporosis treatment group (n=40) were treated with PFNA and received salmon calcitonin and zoledronic acid for sequential therapy based on the supplementation of calcium and active vitamin D, while the control group (n=38) was treated with PFNA only. Bone healing was observed with X-ray and bone mineral density (BMD) was measured regularly by dual energy X-ray absorptiometry after surgery. Harris score was used to evaluate the function of hip joint, and the complications, adverse reaction and subsequent fragility fractures were recorded after surgery. Results All patients were successfully operated, without any complication such as infection and internal fixation failure. X-ray results confirmed that clinical bone healing was achieved in all cases. There were no significant differences in fracture healing time or Harris' hip functional score between the two groups. BMD of contralateral hip joint of patients in the anti-osteoporosis treatment group was significantly higher than that in the control group on the 6 months, 12 months and 18 months after surgery (P<0.05), while the subsequent fragility fracture rate was significantly lower (P<0.05). Conclusion Method for treating elderly patients with osteoporotic femoral intertrochanteric fractures by PFNA conforms to concept of minimally invasive, with simple operation and satisfactory effect. PFNA combined with normalized anti-osteoporosis drugs can increase BMD and reduce subsequent fragile fractures. |
| Key words: proximal femoral nail antirotation osteoporosis femoral intertrochanteric fractures calcitonin zoledronic acid |
