抗骨质疏松药物治疗老年股骨转子间骨折疗效分析
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摘要
目的观察老年骨质疏松性股骨转子间骨折内固定术后应用有效抗骨质疏松药物治疗的疗效。方法选取2013年7月至2014年6月在我院60岁以上诊断为骨质疏松的老年股骨转子间骨折患者57例,分为A组(使用抗骨质疏松药物组30例)和B组(未使用抗骨质疏松药物组27例),骨折术后第5天后行口服维生素D钙咀嚼片、阿伦膦酸钠片治疗,观测骨折愈合时间、骨折并发症、髋关节Harris评分、骨密度。结果完成随访病例A组26例,B组24例,2组骨折愈合时间、骨折并发症无统计学差异(P>0.05),术后12个月髋关节Harris评分A组高于B组,有统计学意义(P<0.05),A组、B组术后3天血清钙及维生素D较术前降低,有统计学意义(P<0.05),A组术后6个月血清钙及维生素D较术前、术后3天增加,有统计学意义(P<0.05),术后6个月A组、B组骨密度较术前无统计学差异(P>0.05),术后12个月A组骨密度较术前增加,有统计学意义(P<0.05),术后12个月B组骨密度较术前无统计学差异(P>0.05)。结论老年骨质疏松性股骨转子间骨折患者术后使用抗骨质疏松治疗能增加骨密度,能获得更好疗效。
Objective To observe the curative effect of anti-osteoporotic drugs on osteoporotic intertrochanteric fractures after internal fixation in the elderly. Methods Fifty-seven elderly patients,who were over 60 years old and diagnosed with osteoporotic intertrochanteric fractures from July 2013 to June 2014 in our hospital,were selected. They were divided into group A( 30 cases,with the use of anti-osteoporotic drugs) and group B( 27 cases,without the use of anti-osteoporotic drugs). Oral D-Cal and alendronate were administered on the fifth day after the surgery. The healing time of the fracture,complications,Harris hip score,and bone mineral density( BMD) were observed. Results Twenty-six cases in group A and 24 cases in group B were completely followed-up. There was no statistical difference in the fracture healing time and complications( P > 0. 05) between the two groups.After 12 months of surgery,the score of Harris in group A was higher than that in group B,with statistical significance( P < 0. 05).The serum calcium and vitamin D levels was lower in two groups three days after surgery than those before the surgery,with statistical significance( P < 0. 05). After 6 months of the surgery,the serum calcium and vitamin D levels in group A increased comparing to those before the surgery and three days after surgery,with statistical significance( P < 0. 05). BMD in group A and group B was not different in 6 months of the surgery. After 12 months of the surgery,BMD increased in group A,but did not increase in group B,comparing to that before the surgery. Conclusion The use of anti-osteoporotic treatment increases BMD in the elderly patients with osteoporotic intertrochanteric fractures,and obtains better curative effect.
Objective To observe the curative effect of anti-osteoporotic drugs on osteoporotic intertrochanteric fractures after internal fixation in the elderly. Methods Fifty-seven elderly patients,who were over 60 years old and diagnosed with osteoporotic intertrochanteric fractures from July 2013 to June 2014 in our hospital,were selected. They were divided into group A( 30 cases,with the use of anti-osteoporotic drugs) and group B( 27 cases,without the use of anti-osteoporotic drugs). Oral D-Cal and alendronate were administered on the fifth day after the surgery. The healing time of the fracture,complications,Harris hip score,and bone mineral density( BMD) were observed. Results Twenty-six cases in group A and 24 cases in group B were completely followed-up. There was no statistical difference in the fracture healing time and complications( P > 0. 05) between the two groups.After 12 months of surgery,the score of Harris in group A was higher than that in group B,with statistical significance( P < 0. 05).The serum calcium and vitamin D levels was lower in two groups three days after surgery than those before the surgery,with statistical significance( P < 0. 05). After 6 months of the surgery,the serum calcium and vitamin D levels in group A increased comparing to those before the surgery and three days after surgery,with statistical significance( P < 0. 05). BMD in group A and group B was not different in 6 months of the surgery. After 12 months of the surgery,BMD increased in group A,but did not increase in group B,comparing to that before the surgery. Conclusion The use of anti-osteoporotic treatment increases BMD in the elderly patients with osteoporotic intertrochanteric fractures,and obtains better curative effect.
引文
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[12]赵瑞林,刘守正,燕好军,等.PFN-A与DHS治疗不稳定性股骨粗隆间骨折的疗效分析.创伤外科杂志,2013,15(4):344-346.Zhao RL,Liu SZ,Yan HJ,et al.Comparison analysis of the effect of PFNA and DHS in the treatment of unstable femoral intertrochanteric hip fracture.J Trauma Surg,2013,15(4):344-346.(in Chinese)
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[14]陈麒麟,朱乐全,冉俊岭,等.锁定钢板治疗老年股骨转子间骨折的临床疗效观察.生物骨科材料与临床研究,2013,10(4):49-51.Chen QL,Zhu LQ,Ran JL,et al.Effects of locking compression plate on the treatment of geriatric femoral intertrochanteric fracture.Orheopaedic Biomechanics Materials and Clinecal Study,2013,10(4):49-51.(in Chinese)
[15]何渝煦,魏庆中,熊启良,等.骨质疏松性骨折与骨密度关系的研究进展.中国骨质疏松杂志,2014,20(2):219-224.He XX,Wei QZ,Xiong QL,et al.Research progress of the relationship between osteopotic fractures and bone mineral density.Chin J Osteoporos,2014,20(2):219-224.(in Chinese)
[16]Arora R,Lutz M,Deml C,et al.A pros pective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty five years of age and older.J Bone Jonint Surg Am,2011,93(23):2146-2153.
[17]St-Arnaud,Naja RP.Viramin D metabolism,cartilage and bone fracture repair.Mol Cell Endocrinol,2011,347(12):48-54.
[18]李长洲,于利,汤欣,等.骨折围手术期血清25羟维生素D及钙水平变化的研究.中国骨质疏松杂志,2015,21(5):618-623.Li CZ,Yu L,Tang X,et al.Study on the change of serum 25hydroxy vitamin D and calcuim levels during perioperative period of fractures.Chin J Osteoporos,2015,21(5):618-623.(in Chinese)
[19]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南.中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.Chinese Medical Asociation of Osteoporosis and Mone Mineral Research Society.Guide for diagnosis and treatment of osteoporosis.Chin J Osteoporosis&Bone Miner Res,2011,4(1):2-17.(in Chinese)
[20]Chung M,Balk EM,Brendel M,et al.Vitamin D and calcium:a systematic review of health outcomes.Evid Rep Technol Assess(Full Rep),2009,183:1-420.
[21]Cranney A,Horsley T,O’Donnell S,et al.Effectiveness and safety of vitamin D in relation to bone health.Evid Rep Technol Assess(Full Rep),2007,158:1-235.
[22]张立,梁铂坚,刘玉槐.对骨质疏松性骨折不要忽视对骨质疏松症的治疗.中国骨质疏松杂志,2011,17(5):457-459.Zhang L,Liang BJ,Liu YH.Do not neglect the trestment of osteoporosis for patients with osteopotic fracture.Chin J Osteoporos,2011,17(5):457-459.(in Chinese)
[2]曾波,熊鸿燕,许建中,等.髋部骨折患者448例流行病学分布特征.中华创伤杂志,2011,27(1):56-59.Zeng B,Xiong HY,Xu JZ,et al.Epidemiological distribution characteristics of hip fractures in 448 patients.Chin J Trauma,2011,27(1):56-59.(in Chinese)
[3]陶天遵,朱汉民,邱贵兴,等.原发性骨质疏松症的治疗与预防.中华骨与关节外科杂志,2015,8(5):377-384.Tao TZ,Zhu HM,Qiu GX,et al.The treatment and prevention of osteoporosis.Chin J Bone&Joint Surg,2015,8(5):377-384.(in Chinese)
[4]廖祥鹏,张增利,张红红,等.维生素D与成年人骨骼健康应用指南(2014年标准版).中国骨质疏松杂志,2014,20(9):1011-1028.Liao XP,Zhang ZL,Zhang HH,et al.Application guideline for vitamin D and bone health in adult chinese.Chin J Osteoporos,2014,20(9):1011-1028.(in Chinese)
[5]申秋红.我国人口老龄化现状及对策研究.科技创新与生产力,2014(7):1-4.Shen QH.Research on population aging in our country present situation and countermeasure.Sci-Tech Innovation&Producticity,2014(7):1-4.(in Chinese)
[6]Xie HB.Prevention and treatment of osteoporosis in the elderly.Chin J Geriatr,2012,31:54-542.
[7]杨丹,栗平,赵平.探讨骨质疏松性骨折的相关影响因素及预防.中国骨质疏松杂志,2014,20(2):152-155.Yang D,Li P,Zhao P.The investingation of the related in fluencing factors of osteoporotic fractures and the related prevention measures.Chin J Osteoporos,2014,20(2):152-155.(in Chinese)
[8]Edards MH,Dennison EM,Cooper C.Can fracture risk be predicted in the elderly.Aging health,2013,9(2):131-133.
[9]Koren L,Barak A,Norman D,et al.Effect of seasonality,weather and holidays on the incidence of proximalhip fracture.Isr Med Assoc J,2014,16(5):299-302.
[10]Zhumkhawala AA,Gleason JM,Cheetham TC,et al.Osteoporosis management program decreases incidence of hip fracture in patients with prostate cancer receiving androgen deprivation therapy.Urology,2013,81(5):1010-1015.
[11]董纪元,李国宏,胡永成,等.老年人股骨转子间骨折围手术期的治疗分析.中华骨科杂志,2010,20(8):476-479.Dong JY,Li GH,Hu YC,et al.The treatment of intertrochanteric fracture in aged patients and morbidity the perioperative period.Chin J Orthop,2010,20(8):476-479.(in Chinese)
[12]赵瑞林,刘守正,燕好军,等.PFN-A与DHS治疗不稳定性股骨粗隆间骨折的疗效分析.创伤外科杂志,2013,15(4):344-346.Zhao RL,Liu SZ,Yan HJ,et al.Comparison analysis of the effect of PFNA and DHS in the treatment of unstable femoral intertrochanteric hip fracture.J Trauma Surg,2013,15(4):344-346.(in Chinese)
[13]王亦璁,姜保国.骨与关节损伤:第5版.北京:人民卫生出版社,2012:1160-1163.Wang YC,Jiang BG.Fractures and Joint Injuries,5/E.Beijing:People’s Medical Press,2012:1160-1163.(in Chinese)
[14]陈麒麟,朱乐全,冉俊岭,等.锁定钢板治疗老年股骨转子间骨折的临床疗效观察.生物骨科材料与临床研究,2013,10(4):49-51.Chen QL,Zhu LQ,Ran JL,et al.Effects of locking compression plate on the treatment of geriatric femoral intertrochanteric fracture.Orheopaedic Biomechanics Materials and Clinecal Study,2013,10(4):49-51.(in Chinese)
[15]何渝煦,魏庆中,熊启良,等.骨质疏松性骨折与骨密度关系的研究进展.中国骨质疏松杂志,2014,20(2):219-224.He XX,Wei QZ,Xiong QL,et al.Research progress of the relationship between osteopotic fractures and bone mineral density.Chin J Osteoporos,2014,20(2):219-224.(in Chinese)
[16]Arora R,Lutz M,Deml C,et al.A pros pective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty five years of age and older.J Bone Jonint Surg Am,2011,93(23):2146-2153.
[17]St-Arnaud,Naja RP.Viramin D metabolism,cartilage and bone fracture repair.Mol Cell Endocrinol,2011,347(12):48-54.
[18]李长洲,于利,汤欣,等.骨折围手术期血清25羟维生素D及钙水平变化的研究.中国骨质疏松杂志,2015,21(5):618-623.Li CZ,Yu L,Tang X,et al.Study on the change of serum 25hydroxy vitamin D and calcuim levels during perioperative period of fractures.Chin J Osteoporos,2015,21(5):618-623.(in Chinese)
[19]中华医学会骨质疏松和骨矿盐疾病分会.原发性骨质疏松症诊治指南.中华骨质疏松和骨矿盐疾病杂志,2011,4(1):2-17.Chinese Medical Asociation of Osteoporosis and Mone Mineral Research Society.Guide for diagnosis and treatment of osteoporosis.Chin J Osteoporosis&Bone Miner Res,2011,4(1):2-17.(in Chinese)
[20]Chung M,Balk EM,Brendel M,et al.Vitamin D and calcium:a systematic review of health outcomes.Evid Rep Technol Assess(Full Rep),2009,183:1-420.
[21]Cranney A,Horsley T,O’Donnell S,et al.Effectiveness and safety of vitamin D in relation to bone health.Evid Rep Technol Assess(Full Rep),2007,158:1-235.
[22]张立,梁铂坚,刘玉槐.对骨质疏松性骨折不要忽视对骨质疏松症的治疗.中国骨质疏松杂志,2011,17(5):457-459.Zhang L,Liang BJ,Liu YH.Do not neglect the trestment of osteoporosis for patients with osteopotic fracture.Chin J Osteoporos,2011,17(5):457-459.(in Chinese)