利塞膦酸钠在骨质疏松性股骨粗隆间骨折中的应用

目的比较应用股骨近端防旋髓内钉(PFNA)联合利塞磷酸钠与单纯行PFNA治疗骨质疏松性股骨粗隆间骨折的临床疗效。方法前瞻性研究2011年1月至2013年4月,采用PFNA治疗62例老年股骨转子间骨折患者资料。术前随机将患者分为利塞膦酸钠组(PFNA治疗联合应用利塞膦酸钠)和对照组(单纯PFNA治疗)。利塞膦酸钠组32例,男15例,女17例;年龄70⁸5岁,平均78岁;按AO分型,A1型10例,A2型18例;A3型4例。对照组30例,男13例,女17例;年龄6885岁,平均78岁;按AO分型,A1型10例,A2型18例;A3型4例。对照组30例,男13例,女17例;年龄68⁸4岁,平均77.5岁;按AO分型,A1型9例,A2型16例;A3型5例。两组患者分别比较术前及术后1年骨密度值。采用Harris评分评价髋关节功能,记录手术相关并发症、药物不良反应及其他部位骨折等情况。结果 60例患者获得1年以上的完整随访,利塞膦酸钠组30例,对照组30例。术后6个月复查时,所有患者骨折均愈合。术前利塞膦酸钠组健侧髋部平均骨密度T值为-2.58±0.41,对照组为-2.56±0.36;术后1年利塞膦酸钠组健侧髋部平均骨密度T值分别为-0.66±0.37,对照组为-1.13±0.28,差异有统计学意义(P=0.000)。术后两组患者Harris评分比较,差异无统计学意义(P=0.238)。利塞膦酸钠组随访期间无再发骨折,对照组1例发生腰椎压缩性骨折,1例发生桡骨远端骨折,2例发生健侧髋部骨折。结论骨质疏松性粗隆间骨折术后早期服用利塞膦酸钠不影响骨折愈合,并可提高健髋骨密度。

Application of risedronate for osteoporotic intertrochanteric fractures

ObjectiveTo compare the clinical outcomes between proximal femoral nail antirotation（PFNA） combined withrisedronate sodium and PFNA only for the treatment of intertrochanteric fractures in elderly patients.Methods From January 2011 to April 2013, 62 elderly patients with intertrochanteric fracture were randomly divided into two groups： risedronate sodium group and control group. Patients in risedronate sodium group were treated with PFNA combined with risedronate sodium, while patients in control group were treated with PFNA only. According to AO classification, 32 patients in risedronate sodium group（15 males and 17 females, with an average age of 78 years） were divided into 10 cases of typeⅠ, 18 cases of typeⅡ and 4 typeⅢ. 30 patients in control group （13 males and 17 females, with an average age of 77.5 years） were divided into 9 cases of typeⅠ, 16 cases of typeⅡ and 5 cases of typeⅢ. Bone healing was assessed with X-ray and bone mineral density （BMD） was measured by dual energy X-ray absorptiometry. Harris hip score, complications,adverse effect of risedronate sodium and subsequent second fractures other than the initial one were evaluated postoperatively. Results 60 patients were followed up for at least one year. All fractures were healed in 6 months after surgery. No significant difference was found between the two groups in BMD preoperatively. The changes in BMD were significantly different between the two groups in one year after surgery. No significant difference was found between the two groups in Harris hip score. NO patient in risedronate group who suffered from subsequent second fractures other than the initial one after surgery, while there was 4 patients in control group postoperatively.Conclusion Early administration by risedronate does not affect the rate of healing of an intertrochanteric fracture and it could increase BMD.