鲑鱼降钙素对老年患者人工肱骨头置换术后影响的疗效观察
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摘要
目的:观察抗骨质疏松药物对老年肱骨近端骨折患者行人工股骨头置换后的疗效影响。方法 :2012年11月至2016年6月肱骨近端骨折行人工肱骨头置换术患者38例,依据术后是否应用抗骨质疏松药物分为治疗组和对照组,治疗组19例,其中3部分骨折11例、4部分骨折8例,骨密度(0.58±0.14) g/cm~2;对照组19例,其中3部分骨折10例、4部分骨折9例,骨密度(0.58±0.11) g/cm~2。检测两组术前、术后4、8、12、24、48周假体周围骨密度(BMD),并行VAS疼痛评分,采用Neer评分系统评价肩关节功能。结果:术后患者切口均为甲级愈合,无并发症发生。35例患者获得1年随访。治疗组假体周围骨密度高于对照组,差异有统计学意义(P<0.05);两组患者术后2、8周VAS评分差异无统计学意义(P>0.05);治疗组Neer评分总分及功能评分优于对照组,差异有统计学意义(P<0.05),疼痛及活动度评分两组比较,差异无统计学意义(P>0.05)。依据Neer评分系统,治疗组优10例,良5例,可3例;对照组优3例,良9例,可5例;两组比较差异有统计学意义(P<0.05)。结论:人工肱骨头置换结合抗骨质疏松药物治疗老年肱骨近端骨折可有效提高假体周围骨密度,恢复肩关节功能,早期临床效果满意。
Objective:To observe the effect of anti-osteoporosis drugs on the curative effect of femoral head replacement in the elderly patients with proximal humerus fracture. Methods:From November 2012 to June 2016,38 patients with proximal humeral fractures received humeral head replacement were divided into the treatment group and the control group according to whether the anti-osteoporosis drugs were used after the operation. The treatment group included 19 cases,of which 11 cases were three part fractures,18 cases were four part fractures,and bone density was(0.58 ±0.14)g/cm~2;the control group involved 19 cases,of which 10 cases were the three part fractures,9 cases were four part fractures,and bone density was(0.58±0.11) g/cm~2.Periprosthetic bone mineral density(BMD) was measured at 4,8,12,24 and 48 weeks after operation,and visual analogue scale(VAS) was used to evaluate the pain and Neer score was used to evaluate the function of the shoulder joint. Results:The incisions of all patients were healed with grade A and no complications occurred. Thirty-five patients were followed up for 1 year. The bone density around the prosthesis of treatment group was higher than that of control group,the difference was statistically significant(P<0.05);VAS in two groups had no statistical significance(P>0.05). The total score and functional score of Neer in the treatment group were better than those in the control group,the difference was statistically significant(P<0.05),and there was no significant difference in pain and activity score between the two groups(P>0.05). According to the Neer score,the results of treatment group was excellent in 10 cases,good in 5 cases,fair in 3 cases;in the control group,3 cases were excellent,9 cases were good,and 5 cases were fair;the difference between the two groups was statistically significant(P<0.05). Conclusion:Artificial humeral head replacement combined with anti-osteoporosis drugs in the treatment of proximal humeral fractures in elderly patients can effectively improve the bone density around the prosthesis and restore shoulder function. The early clinical effect is satisfactory.
Objective:To observe the effect of anti-osteoporosis drugs on the curative effect of femoral head replacement in the elderly patients with proximal humerus fracture. Methods:From November 2012 to June 2016,38 patients with proximal humeral fractures received humeral head replacement were divided into the treatment group and the control group according to whether the anti-osteoporosis drugs were used after the operation. The treatment group included 19 cases,of which 11 cases were three part fractures,18 cases were four part fractures,and bone density was(0.58 ±0.14)g/cm~2;the control group involved 19 cases,of which 10 cases were the three part fractures,9 cases were four part fractures,and bone density was(0.58±0.11) g/cm~2.Periprosthetic bone mineral density(BMD) was measured at 4,8,12,24 and 48 weeks after operation,and visual analogue scale(VAS) was used to evaluate the pain and Neer score was used to evaluate the function of the shoulder joint. Results:The incisions of all patients were healed with grade A and no complications occurred. Thirty-five patients were followed up for 1 year. The bone density around the prosthesis of treatment group was higher than that of control group,the difference was statistically significant(P<0.05);VAS in two groups had no statistical significance(P>0.05). The total score and functional score of Neer in the treatment group were better than those in the control group,the difference was statistically significant(P<0.05),and there was no significant difference in pain and activity score between the two groups(P>0.05). According to the Neer score,the results of treatment group was excellent in 10 cases,good in 5 cases,fair in 3 cases;in the control group,3 cases were excellent,9 cases were good,and 5 cases were fair;the difference between the two groups was statistically significant(P<0.05). Conclusion:Artificial humeral head replacement combined with anti-osteoporosis drugs in the treatment of proximal humeral fractures in elderly patients can effectively improve the bone density around the prosthesis and restore shoulder function. The early clinical effect is satisfactory.
引文
[1]王蕾.肱骨近端骨折的治疗理念与思考[J].中国骨伤,2013,26(1):1-3.WANG L.Treatment idea and thinking of proximal humeral fracture[J].Zhongguo Gu Shang/China J Orthop Trauma,2013,26(1):1-3.Chinese.
[2]Kannus P,Palvanen M,Niemi S,et al.Rate of proximal humeral fractures in older finnish women between 1970 and 2007[J].Bone,2009,44(4):656-659.
[3]Hornblow AR,Kidson MA.The visual analogue scale for anxiety:a validation study[J].Aust N Z J Psychiatry,1976,10(4):339-341.
[4]Neer CS 2nd.Displaced proximal humeral fractures.Ⅰ.Classification and evaluation[J].J Bone Joint Surg Am,1970,52(6):1077-1089.
[5]Laguesse R,Rossion B.Face perception is whole or none:disentangling the role of spatial contiguity and interfeaturedistances in the composite face illusion[J].Perception,2013,42(10):1013-1026.
[6]蒋电明,苏保.肱骨近端骨折治疗方法选择与现状[J].中国骨伤,2014,27(12):975-979.JIANG DM,SU B.Present status and choice of treatment for proximal humeral fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(12):975-979.Chinese with abstract in English.
[7]Baudi P,Campochiaro G,Serafini F,et al.Hemiarthroplasty versus reverse shoulder arthroplasty:comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture[J].Musculoskelet Surg,2014,98(Suppl 1):19-25.
[8]Chalmers PN,Slikker W 3rd,Mall NA,et al.Reverse total shoulder arthroplasty for acute proximal humeral fracture:comparison to openreduction-internal fixation and hemiarthroplasty[J].J Shoulder Elbow Surg,2014,23(2):197-204.
[9]Pfeifer M,Begerow B,Minne HW.Vitamin D and muscle function[J].Osteoporos Int,2002,13(3):187-194.
[10]赵弟庆,马创,杨广忠,等.锁定钢板结合抗骨质疏松药物治疗老年骨质疏松性肱骨近端骨折的疗效分析[J].医学研究生学报,2014,27(6):619-622.ZHAO DQ,MA C,YANG GZ,et al.Efficacy of locking plate combined with anti osteoporotic drugs in the treatment of osteoporotic proximal humeral fractures in the elderly[J].Yi Xue Yan Jiu Sheng Xue Bao,2014,27(6):619-622.Chinese.
[11]王建,陈杰妮.降钙素在老年性肱骨近端粉碎性骨折中的应用[J].实用医学杂志,2015,31(2):237-240.WANG J,CHEN JN.Application of calcitonin in elderly patients with comminuted proximal humeral fractures[J].Shi Yong Yi Xue Za Zhi,2015,31(2):237-240.Chinese.
[12]Rosas S,Law TY,Kurowicki J,et al.Trends in surgical management of proximal humeral fractures in the Medicare population:a nationwide study of records from 2009 to 2012[J].J Shoulder Elbow Surg,2016,25(4):608-613.
[13]季峰,谢跃,王守国,等.人工肱骨头置换治疗肱骨近端4部分骨折的疗效分析[J].山东医药,2012,52(45):87-89.JI F,XIE Y,WANG SG,et al.Artificial humeral head replacement for the treatment of four part proximal humeral fractures[J].Shan Dong Yi Yao,2012,52(45):87-89.Chinese.
[14]姜春岩,李奉龙,鲁谊,等.反球型人工肩关节假体置换术治疗复杂肱骨近端骨折[J].中华创伤骨科杂志,2014,16(10):834-838.JIANG CY,LI FL,LU Y,et al.Treatment of complex proximal humeral fractures with prosthetic shoulder prosthesis replacement[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2014,16(10):834-838.Chinese.
[15]Sirveaux F,Roche O,MoléD.Shoulder arthroplasty for acute proximal humerus fracture[J].Orthop Traumatol Surg Res,2010,96(6):683-694.
[16]Cuff DJ,Pupello DR.Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients[J].J Bone Joint Surg Am,2013,95(22):2050-2055.
[17]Myers JB,Oyama S,Clarke JP.Ultrasonographic assessment of humeral retrotorsion in baseball players:a validation study[J].Am J Sports Med,2012,40(5):1155-1160.
[18]戴海峰,徐丛,王智慧,等.半肩关节置换术治疗骨质疏松性肱骨近端粉碎性骨折26例[J].山东医药,2017,57(7):74-76.DAI HF,XU C,WANG ZH,et al.Treatment of 26 cases of osteoporotic comminuted proximal humeral fractures with hemiarthroplasty[J].Shan Dong Yi Yao,2017,57(7):74-76.Chinese.
[19]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨折诊断及治疗原则)[J].中华骨与关节外科杂志,2015,8(5):371-374.QIU GX,PEI FX,HU ZM,et al.Guidelines for diagnosis and treatment of osteoporotic fractures in China(diagnosis and treatment principle of osteoporotic fracture)[J].Zhonghua Gu Yu Guan Jie Wai Ke Za Zhi,2015,8(5):371-374.Chinese.
[2]Kannus P,Palvanen M,Niemi S,et al.Rate of proximal humeral fractures in older finnish women between 1970 and 2007[J].Bone,2009,44(4):656-659.
[3]Hornblow AR,Kidson MA.The visual analogue scale for anxiety:a validation study[J].Aust N Z J Psychiatry,1976,10(4):339-341.
[4]Neer CS 2nd.Displaced proximal humeral fractures.Ⅰ.Classification and evaluation[J].J Bone Joint Surg Am,1970,52(6):1077-1089.
[5]Laguesse R,Rossion B.Face perception is whole or none:disentangling the role of spatial contiguity and interfeaturedistances in the composite face illusion[J].Perception,2013,42(10):1013-1026.
[6]蒋电明,苏保.肱骨近端骨折治疗方法选择与现状[J].中国骨伤,2014,27(12):975-979.JIANG DM,SU B.Present status and choice of treatment for proximal humeral fractures[J].Zhongguo Gu Shang/China J Orthop Trauma,2014,27(12):975-979.Chinese with abstract in English.
[7]Baudi P,Campochiaro G,Serafini F,et al.Hemiarthroplasty versus reverse shoulder arthroplasty:comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture[J].Musculoskelet Surg,2014,98(Suppl 1):19-25.
[8]Chalmers PN,Slikker W 3rd,Mall NA,et al.Reverse total shoulder arthroplasty for acute proximal humeral fracture:comparison to openreduction-internal fixation and hemiarthroplasty[J].J Shoulder Elbow Surg,2014,23(2):197-204.
[9]Pfeifer M,Begerow B,Minne HW.Vitamin D and muscle function[J].Osteoporos Int,2002,13(3):187-194.
[10]赵弟庆,马创,杨广忠,等.锁定钢板结合抗骨质疏松药物治疗老年骨质疏松性肱骨近端骨折的疗效分析[J].医学研究生学报,2014,27(6):619-622.ZHAO DQ,MA C,YANG GZ,et al.Efficacy of locking plate combined with anti osteoporotic drugs in the treatment of osteoporotic proximal humeral fractures in the elderly[J].Yi Xue Yan Jiu Sheng Xue Bao,2014,27(6):619-622.Chinese.
[11]王建,陈杰妮.降钙素在老年性肱骨近端粉碎性骨折中的应用[J].实用医学杂志,2015,31(2):237-240.WANG J,CHEN JN.Application of calcitonin in elderly patients with comminuted proximal humeral fractures[J].Shi Yong Yi Xue Za Zhi,2015,31(2):237-240.Chinese.
[12]Rosas S,Law TY,Kurowicki J,et al.Trends in surgical management of proximal humeral fractures in the Medicare population:a nationwide study of records from 2009 to 2012[J].J Shoulder Elbow Surg,2016,25(4):608-613.
[13]季峰,谢跃,王守国,等.人工肱骨头置换治疗肱骨近端4部分骨折的疗效分析[J].山东医药,2012,52(45):87-89.JI F,XIE Y,WANG SG,et al.Artificial humeral head replacement for the treatment of four part proximal humeral fractures[J].Shan Dong Yi Yao,2012,52(45):87-89.Chinese.
[14]姜春岩,李奉龙,鲁谊,等.反球型人工肩关节假体置换术治疗复杂肱骨近端骨折[J].中华创伤骨科杂志,2014,16(10):834-838.JIANG CY,LI FL,LU Y,et al.Treatment of complex proximal humeral fractures with prosthetic shoulder prosthesis replacement[J].Zhonghua Chuang Shang Gu Ke Za Zhi,2014,16(10):834-838.Chinese.
[15]Sirveaux F,Roche O,MoléD.Shoulder arthroplasty for acute proximal humerus fracture[J].Orthop Traumatol Surg Res,2010,96(6):683-694.
[16]Cuff DJ,Pupello DR.Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients[J].J Bone Joint Surg Am,2013,95(22):2050-2055.
[17]Myers JB,Oyama S,Clarke JP.Ultrasonographic assessment of humeral retrotorsion in baseball players:a validation study[J].Am J Sports Med,2012,40(5):1155-1160.
[18]戴海峰,徐丛,王智慧,等.半肩关节置换术治疗骨质疏松性肱骨近端粉碎性骨折26例[J].山东医药,2017,57(7):74-76.DAI HF,XU C,WANG ZH,et al.Treatment of 26 cases of osteoporotic comminuted proximal humeral fractures with hemiarthroplasty[J].Shan Dong Yi Yao,2017,57(7):74-76.Chinese.
[19]邱贵兴,裴福兴,胡侦明,等.中国骨质疏松性骨折诊疗指南(骨质疏松性骨折诊断及治疗原则)[J].中华骨与关节外科杂志,2015,8(5):371-374.QIU GX,PEI FX,HU ZM,et al.Guidelines for diagnosis and treatment of osteoporotic fractures in China(diagnosis and treatment principle of osteoporotic fracture)[J].Zhonghua Gu Yu Guan Jie Wai Ke Za Zhi,2015,8(5):371-374.Chinese.