抗旋转股骨近端髓内钉内固定术联合阿仑膦酸钠治疗老年股骨粗隆间骨折效果观察

摘要

Objective To investigate the clinical effect of proximal femoral nail anti-rotation PFNA) combined with alendronate in treating femoral intertrochanteric fracture in elderly patients.Methods Totally 57 elderly patients with femoral intertrochanteric fiacture from January 2010 to January 2014 were randomly divided into observation group (28 cases) and control group (29 cases).All patients were treated with PFNA and oral calcium D3 tablets (600 mg, once a day).Two weeks after surgery, the patients in observation group were treated with oral alendronate (70 mg, once a week).The treatment was lasted for one year.The postoperative complications, fracture healing time, function of hip joint and bone mineral density of L2-4 vertebral body after treatment were compared between groups.Results No nonunion or malunion, screw loosening and wound infection, fat embolism and deep vein thrombosis occurred in both groups.The fracture healing time and function of hip function were not statistically different (P ＞ 0.05).The bone mineral density of L2-4 vertebral body in observation group was significantly higher than that in control group after treatment [(0.79 ± 0.10) g/cm2 vs (0.64 ± 0.04) g/cm2](P ＜ 0.05).During 10-20 months of followed-up, the rate of refracture observation group was significantly lower than that in control group [0.0％ (0/28) vs 13.8％ (4/29)] (P ＜0.05).Conclusion PFNA combined with alendronate has good effect in treating femoral intertrochanteric fractures in elderly patients, and can increase the bone density and prevent recurrent fracture.%目的 探讨抗旋转股骨近端髓内钉(PFNA)内固定联合阿仑膦酸钠治疗老年股骨粗隆间骨折的效果.方法 选择唐山市中医医院2010年1月至2014年1月收治的老年股骨粗隆间骨折患者57例,根据随机数字表法分为观察组(28例)与对照组(29例),2组均给予PFNA内固定治疗,术后均给予碳酸钙D3片600 mg,1次/d,口服.观察组术后2周给予阿仑膦酸钠70 mg口服,每周1次.2组疗程均为1年.观察2组患者手术相关并发症、骨折愈合时间、髋关节功能、抗骨质疏松治疗结束后L2～4椎体骨密度水平以及再骨折发生情况.结果 2组患者均未发生骨折不愈合或畸形愈合,无螺钉松动和伤口感染,未见脂肪栓塞、深静脉血栓等.观察组与对照组患者骨折愈合时间、髋关节功能比较,差异无统计学意义(P＞0.05),骨密度比较[(0.79 ±0.10)g/cm2比(0.64 ±0.04)g/cm2],差异有统计学意义(P＜0.05).术后随访10～20个月,观察组患者未见其他部位再骨折,对照组4例发生其他部位再骨折[0.0％ (0/28)比13.8％ (4/29)],2组比较差异有统计学意义(P＜0.05).结论 PFNA内固定联合阿仑膦酸钠治疗老年股骨粗隆间骨折临床效果较好,并能提高骨密度,预防再骨折的发生.