唑来膦酸对骨质疏松性股骨转子间骨折作用效果分析

 目的 比较应用唑来膦酸与降钙素对老年骨质疏松性股骨转子间骨折疗效的影响。方法 回顾性分析 2009年6月到2012年11月，采用闭合复位髓内钉固定术治疗610例骨质疏松性转子间骨折患者资料，按照入院顺序及是否获得完整随访资料将543例患者分为两组。其中降钙素组325例，2009年6月至2011年4月手术，男107例，女218例； 年龄(75.02±5.65)岁；Evans?Jensen分型：Ⅰ型87例，Ⅱ型136例，Ⅲ型102例；腰椎骨密度平均(0.737±0.08) g/cm²，髋部平均 (0.725±0.05)g/cm²；应用降钙素等治疗。唑来膦酸组218例，2011年5月至2012年11月手术，男82例，女136例； 年龄(74.71±5.32)岁；Evans?Jensen分型：Ⅰ型62例，Ⅱ型91例，Ⅲ型65例；腰椎骨密度平均为(0.738±0.05)g/cm²，髋部平均为(0.722±0.06)g/cm²；术后7d内使用唑来膦酸治疗。两组患者分别比较住院期间及术后1年骨密度值。采用Harris评分、视觉模拟评分(visual analogue score, VAS)评价髋关节功能和疼痛程度。结果 降钙素组随访时间为5～22个月，平均 12.8个月；唑来膦酸组随访时间为4～19个月，平均12.5个月。患者影像学骨折愈合时间、Harris评分、VAS评分，唑来膦酸组分别为(14.25±1.38)周、(68.88±5.71)分、(0.36±0.55)分；降钙素组分别为(14.39±1.12)周、(69.47±4.60)分、(0.33± 0.48)分；两组各指标比较，差异无统计学意义。术后1年唑来膦酸组腰椎骨密度平均为(0.76±0.06)g/cm²，髋部平均为 (0.75±0.04)g/cm²，降钙素组腰椎骨密度平均为(0.75±0.07)g/cm²，髋部平均为(0.74±0.07) g/cm²。唑来膦酸组患者术后1 年与术前骨密度比较差异有统计学意义。术后1年，两组骨密度比较，差异有统计学意义。结论 老年骨质疏松性股骨 转子间骨折内固定术后应用唑来膦酸未对骨折愈合和髋关节功能恢复造成影响，术后1年骨密度明显升高。

The effect of zoledronic acid on osteoporotic intertrochanteric fractures

Objective To compare of the effect of intravenous zoledronic acid and calcitonin on the elderly with osteoporotic intertrochanteric fractures. Methods From June 2009 to November 2012, 610 patients with osteoporotic intertrochanteric fractures were treated with closed reduction and internal fixation. 543 consecutive patients were grouped sequentially according to the admission time. From June 2009 to April 2011, control group（n=325）received calcitonin for osteoporosis (male 107, female 218, mean age 75.02±5.65 years). The number of Evans?Jensen type I , II , and III type patients were 87, 136, and 102, respectively. Average lumbar bone mineral density (BMD) and hip BMD were 0.737±0.08 g/cm² and 0.725±0.05 g/cm², respectively. From May 2011 to November 2012, 218 patients (male 82, female 136, mean age 74.71±5.32 years ) received zoledronic acid for osteoporosis. The number of Evans?Jensen type I , II , and III type patient were 62, 91 and 65, respectively. Average lumbar BMD and hip BMD were 0.738±0.05 g/cm² and 0.722±0.06 g/cm², respectively. All patients received once?yearly intravenous zoledronic acid in one week after operation. The BMD during hospitalization and one year after operation were compared between the two groups. Harris score and VAS score were applied to evaluate the function and pain degree of the operated hip joint. Results The average follow?up time were 12.8 months (range, 5 to 22 months) in control group and 12.5 months (range, 4 to 19 months) in treatment group. The average fracture union time, Harris score, VAS score were 14.25±1.38 weeks, 68.88±5.71 points, and 0.36±0.55 points respectively in treatment group and 14.39±1.12 weeks, 69.47±4.60 points, and 0.33±0.48 points respectively in control group. There were no statistical differences between two groups in fracture union time, Harris score and VAS score. The average lumbar BMD and hip BMD were 0.76±0.06 g/cm² and 0.75±0.04 g/cm² in treatment group, which were 0.75±0.07 g/cm² and 0.74± 0.07 g/cm² in control group one year after operation, respectively. Compared with the baseline, the BMD of lumbar spine and hip one year after operation slightly increased without statistically significant difference in control group. The BMD increased significantly in treatment group. Conclusion Early administration of intravenous zoledronic acid does not influence bone healing and it could increase BMD one year after closed reduction and internal fixation