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对比观察

目的对比观察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2010年1月~2013年6月宜昌市中心人民医院采用闭合复位髓内钉固定术治疗骨质疏松性转子间骨折的患者260例。A组127例患者术后2周内每天皮下注射降钙素50IU,2周后使用降钙素鼻喷剂20μg/日喷鼻治疗;B组133例患者术后2周内静脉滴注唑来膦酸5mg,2周后每天服用阿仑膦酸钠70mg。比较两组患者骨折术后愈合时间、术后1年的Harris评分、VAS评分,以及A组和B组骨折术后1周和术后1年腰椎和髋部骨密度。结果 A组和B组骨折术后愈合时间分别为(103±28.7)d和(104±29.8)d,差异不显著(P0.05);术后1年Harris评分(68.87±4.78)和(69.21±4.67)、VAS评分(0.34±0.37)和(0.33±0.38),比较差异均不显著(P0.05);术后1周腰椎和髋部骨密度分别为(0.77±0.06)和(0.76±0.05)g/cm2,差异均不显著(P0.05);术后1年腰椎和髋部骨密度分别为(0.78±0.05)和(0.80±0.05)g/cm2,有显著差异(P0.05)。A组患者术后1周和术后1年腰椎和髋部骨密度分别为(0.77±0.06)、(0.78±0.05)g/cm2和(0.72±0.05)、(0.73±0.07)g/cm2,无显著差异(P0.05),B组患者分别为(0.76±0.05)、(0.79±0.05)g/cm2和(0.73±0.04)、(0.76±0.05)g/cm2,比较有显著差异(P0.05),且术后1年B组患者的骨密度恢复明显优于A组(P0.05)。结论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短时间内差异不明显,在术后较长时间恢复中唑来膦酸更有利于骨密度增加。

The effect of intravenous zoledronic acid and calcitonin on the elderly with osteoporotic intertrochanteric fractures

Objective To compare the effect of zoledronic acid and calcitonin on the elderly with osteoporotic intertrochanteric fractures.Methods A retrospective analysis was performed among 260 patients using closed reduction and intramedullary nail fixation for the treatment of osteoporotic intertrochanteric fracture.Group A with 127 cases were taking calcitonin and group B with 133 patients were taking zoledronic acid.Fracture healing time after surgery,Harris score 1 year after surgery,VAS score,bone density of lumbar spine and hip 1 week and 1 year after surgery of the two groups were analyzed.Results Fracture healing time after surgery of group A and group B were 103±28.7 days and 104±29.8 days(P>0.05),respectively.Harris score 1 year after surgery(68.87±4.78) vs.(69.21±4.67)],VAS score(0.34±0.37) vs.(0.33±0.38)] and bone density of lumbar spine and hip 1 week after surgery (0.77±0.06)vs.(0.76±0.05)g/cm2] of two groups were not significantly different(P>0.05).Bone density of lumbar spine and hip 1 year after surgery of two group was significantly different(0.78±0.05)vs.(0.80±0.05)g/cm2,P<0.05).There was no significant difference of bone density of lumbar spine and hip 1 week and 1 year after surgery in group A(PP>0.05).There was significant difference of bone density of lumbar spine and hip 1 week and 1 year after surgery in group B(P<0.05),and after 1 year the bone density of the patients in group B was better than that of group A(P<0.05).Conclusion The effect of intravenous zoledronic acid and calcitonin on the elderly with osteoporotic intertrochanteric fractures is not significantly different in short term.Zoledronic acid is much more conducive to the improvement of bone density in long period after surgery.