经皮加压钢板联合唑来膦酸治疗老年骨质疏松性股骨颈骨折疗效分析

目的探讨经皮加压钢板联合唑来膦酸治疗老年骨质疏松性股骨颈骨折（OFNF）的临床疗效。 方法选取2014年6月至2019年6月常熟市第一人民医院收治的98例老年OFNF患者，其中48例采用经皮加压钢板+唑来膦酸治疗（观察组），50例采用全髋或半髋关节置换+常规治疗（对照组）。比较两组患者手术前后的骨密度与骨代谢标志物变化，临床疗效，术后视觉模拟评分法（VAS）疼痛评分、Harris髋关节功能评分，以及并发症的总体发生率。计量资料的比较采用t检验和重复测量方差分析，计数资料的比较采用χ²检验。 结果与对照组患者比较，观察组患者住院时间明显缩短、手术时间和术中出血量明显减少、术后血红蛋白下降量明显降低（t=-3.050、-10.379、-21.032、-31.908，P<0.05）。两组患者术前髋部骨密度和T值、Ⅰ型前胶原氨基端肽（PⅠNP）和β-Ⅰ型胶原羧基末端肽（β-CTX）水平均无明显差异，术后的差异均呈现出时间效应、组间效应及其交互效应（骨密度：F=28.491、15.609、6.128，P<0.01；T值：F=45.358、27.736、6.133，P<0.01；PⅠNP：F=73.84、88.812、16.991，P<0.01；β-CTX：F=101.431、724.919、44.086，P<0.01）。两组患者术后VAS评分的差异呈现出时间效应、组间效应及其交互效应（F=1678.032、552.403、32.493，P<0.01），术后Harris评分的差异呈现出时间效应和组间效应（F=33.344、14.169，P<0.01）。 结论采用经皮加压钢板结合唑来膦酸治疗老年OFNF，不仅能够早期重建髋关节功能，而且术后疼痛较轻，功能恢复快。

Percutaneous compression plate combined with zoledronic acid in the treatment of senile osteoporotic femoral neck fracture

ObjectiveTo investigate the clinical effect of percutaneous compression plate combined with zoledronic acid in the treatment of senile osteoporotic femoral neck fracture (OFNF). MethodsA total of 98 elderly OFNF patients admitted to the First People's Hospital of Changshu from June 2014 to June 2019 were selected. Among them, 48 patients were treated with percutaneous compression plate plus zoledronic acid (observation group), and 50 patients were treated with total or semi-hip replacement plus routine treatment (control group). The changes of bone mineral density and bone metabolism markers, clinical efficacy, postoperative visual analog scale (VAS) pain score, Harris hip function score, and the overall incidence of complications were compared between 2 groups before and after surgery. T test and repeated-measure ANOVA was used for comparison of measurement data, and χ² test was used for comparison of counting data. ResultsCompared with the control group, the hospitalization time, operation time and intraoperative bleeding of the observation group were significantly shortened, and the decrease of postoperative hemoglobin was significantly reduced (t=-3.050, -10.379, -21.032, -31.908, P < 0.05). There were no significant differences in preoperative hip BMD and T value, the amino-terminal peptide of type Ⅰ procollagen (PⅠNP) and the carboxy-terminal peptide crosslinking of β-Ⅰ collagen (β-CTX) between two groups, and the postoperative differences showed time effect, group effect and interaction effect (BMD: F=28.491, 15.609, 6.128, P < 0.01; T value: F=45.358, 27.736, 6.133, P < 0.01; PⅠNP: F=73.84, 88.812, 16.991, P < 0.01; β-CTX: F=101.431, 724.919, 44.086, P < 0.01). The difference of postoperative VAS score between the two groups showed time effect, group effect and interaction effect (F=1678.032, 552.403, 32.493, P < 0.01), and the difference of postoperative Harris score showed time effect and group effect (F=33.344, 14.169, P < 0.01). ConclusionThe use of percutaneous compression plate combined with zoledronic acid in the treatment of senile OFNF can not only restore the hip function early, but also reduce the postoperative pain and recover the function quickly.