鲑鱼降钙素联合手术治疗骨质疏松性桡骨远端背侧不稳定性骨折对患者术后疗效及骨密度改变的分析

目的 观察鲑鱼降钙素联合手术治疗老年骨质疏松性桡骨远端背侧不稳定性骨折患者术后疗效及骨密度的改变.方法 45例桡骨远端背侧不稳定性骨折患者,其中男10例,女35例,年龄60～83岁,平均(68.5±6.8)岁,按AO/ASIF分型如下:A3型2例,B2型6例,B3型8例,C1型13例,C2型10例,C3型6例.将患者随机分为研究组(24例)及对照组(21例),均采用掌侧锁定加压钢板(LCP)结合经皮克氏针撬拨技术手术治疗,术后研究组予肌注鲑鱼降钙素及口服钙尔奇D600抗骨质疏松治疗,对照组仅口服钙尔奇D600,两组药物给予时间均为3个月.根据Stewart等改良的Sarmiento评分标准及改良的Mcbride腕关节功能评价标准分别行影像学及腕关节功能评估,测定两组患者术前及术后3个月时骨密度值,比较两组术后疗效、骨折愈合时间及骨密度,并对结果进行统计学分析.结果 所有病例均在门诊获得随访,随访时间8 ～ 32个月,平均16个月.改良的Sarmiento影像学评分研究组优17例(70.8％),良7例(29.2％)；对照组优13例(61.9％),良8例(38.1％).改良的Mcbride腕关节功能评分研究组优16例(66.7％),良6例(25.0％),可2例(8.3％)；对照组优7例(33.3％),良9例(42.9％),可5例(23.8％).骨折愈合时间分别为:研究组(6.5±1.4)周,对照组(8.3±2.1)周,差异有显著性(P＜0.05).研究组骨密度术前(0.618 ±0.105) g/cm2,术后药物治疗3个月后为(0.660±0.092) g/cm2,差异有显著性(P＜0.05)；对照组骨密度术前(0.621±0.085)g/cm2,术后药物治疗3个月后为(0.627±0.089)g/cm2,差异无显著性(P＞0.05)；两组术后3个月时骨密度比较差异有显著性(P＜0.05).结论 掌侧LCP结合经皮克氏针撬拨技术是治疗老年骨质疏松性桡骨远端背侧不稳定性骨折的一种有效方法,背侧骨块复位满意,固定牢靠,可减少复位丢失、结构性植骨,术后联合使用鲑鱼降钙素抗骨质疏松治疗可增加骨密度,进一步加强内固定效果,促进骨折愈合,提高腕关节功能.

Efficacy of salmon calcitonin combined with operation on the treatment of osteoporotic dorsal unstable distal radial fractures and the analysis of the changes of bone mineral density

Objective To observe the efficacy of salmon calcitonin combined with operation on the treatment of osteoporotic dorsal unstable distal radial fractures and the changes of bone mineral density. Methods Forty-five patients (10 men and 35 women), aging from 60 to 83 years old, with an average age of 68.5±6.8 years old, who had dorsal unstable distal radial fractures, were selected. According to AO/ASIF classification, there were 2 patients of A3 type, 6 patients of B2 type, 8 patients of B3 type, 13 patients of C1 type, 10 patients of C2 type, and 6 patients of C3 type. All the patients were randomly divided into two groups: 24 patients in research group and 21 patients in control group. All the patients were treated with volar LCP combined with percutaneous Kirschner wire reduction. Patients in research group received salmon calcitonin injection and oral medication of caltrate D600 for anti-osteoporosis treatment after the operation. Patients in control group were given oral medication of caltrate D600 only. The whole period lasted for 3 months. The radiographic results were evaluated by modified Sarmiento scale. The wrist function was evaluated by modified Mcbride evaluation system. Preoperative and 3-month postoperative BMD values were detected. Comparison of effects, bone healing time, and BMD were performed. All the results were analyzed statistically. Results All patients were followed up for 8 to 32 months (16 months in average) in the outpatient department. According to modified Sarmiento scale, there were 17 excellent cases (70.8%) and 7 good cases (29.2%) in research group, while 13 excellent cases (61.9%) and 8 good cases (38.1%) in control group. Wrist function assessment evaluated with modified Mcbride system were 16 excellent (66.7%) , 6 good (25.0%), and 2 fair (8.3%) in research group, while 7 excellent (33.3%), 9 good (42.9%), and 5 fair (23.8%) in control group. The bone healing time was 6.5±1.4 weeks in research group and 8.3±2.1 weeks in control group, showing significant difference between two groups (P<0.05). BMD in research group was 0.618±0.105 g/cm2 preoperatively, and 0.660±0.092 g/cm2 3 months after surgery, and showed significant difference (P<0.05). BMD in control group was 0.621±0.085 g/cm2 preoperatively, and 0.627±0.089 g/cm2 3 months after surgery, and showed no significant difference (P>0.05). Significant difference was found in BMD between the two groups 3 months after surgery (P<0.05). Conclusion Volar LCP combined with percutaneous Kirschner wire reduction by leverage is an effective method for the treatment of dorsal unstable distal radial fractures in osteoporotic patients. It provides satisfactory dorsal reduction and stable fixation, prevents reduction lost, and reduces structural bone grafting. Anti-osteoporotic therapy combined with salmon calcitonin can increase BMD, enhance the internal fixation, promote bone healing, and increase the wrist function.