中西药联合使用结合保守治疗对老年骨质疏松性肱骨近端骨折影响的临床研究

摘要

目的 分析中西药联合使用结合保守治疗在老年骨质疏松性肱骨近端骨折患者中的疗效.方法 选取老年骨质疏松性肱骨近端骨折患者100 例,将100 例患者随机分为治疗组( n＝50)和对照组( n＝50).所有患者均给予手法复位结合可调节上肢外展架治疗,治疗组在此基础上给予阿仑膦酸钠联合仙灵骨葆,为期12个月.比较治疗前后患者骨折愈合时间、并发症发生情况,骨代谢和骨密度等指标改变.结果 治疗后1个月、3个月、6个月及12个月时两组患者疼痛情况比较,治疗组疼痛数字分级法(numeric pain intensity scale,NPIS)评分明显低于对照组(P＜0. 05),随访12 个月时治疗组患者肩关节功能恢复情况明显优于对照组(P＜0. 05),治疗组术后并发症发生率明显低于对照组(P＜0. 05),治疗组骨折愈合时间明显短于对照组(P＜0. 05).治疗6个月、12 个月后,治疗组患者腰椎正位(L2～4)、左股骨颈的骨密度和血清骨钙素水平均明显高于对照组,而治疗组血清β-CTX 水平较对照组明显降低,差异均有统计学意义( P＜0. 05);治疗6个月、12个月后,两组患者血清N端中段骨钙素水平与治疗前的差异无统计学意义(P＞0. 05).结论 阿仑膦酸钠联合仙灵骨葆治疗对老年骨质疏松性肱骨近端骨折外展架固定后安全有效,能够有效减轻患者疼痛,加速骨折愈合,改善患者肩关节功能,降低治疗后并发症的发生率.%Objective To evaluate the efficacy of combined use of traditional Chinese and western medicine in combination with conservative treatment in elderly patients with osteoporotic proximal humerus fractures. Methods 100 patients with osteoporotic proximal humerus fractures were randomly divided into treatment group ( n＝50) and control group ( n＝50). All patients were given a manual reduction combined with an adjustable upper limb extubation treatment. The treatment group additionally received alendronate sodium combined with Xianlinggubao treatment for 12 months. Healing time, complication, bone metabolism and bone mineral density were compared before and after treatment. Results 1, 3, 6 and 12 months after treatment, the scores of NRS in the treatment group were significantly lower than those in the control group (P＜0. 05), and the shoulder function was significantly better in the treatment group than that the control group at 12 months (P＜0. 05). The incidence of postoperative complications in the treatment group was significantly lower than that in the control group ( P ＜0. 05 ), and the time of fracture healing was significantly shorter in the treatment group than that in the control group (P＜0. 05). After treatment for 6 and 12 months, BMD of the lumbar spine (L2-4), left femoral neck and serum BGP were significantly higher in the treatment group than in the control group, while the level of serum β-CTX in the treatment group was significantly lower than that in the control group, and the difference was statistically significant (P＜0. 05). There was no significant difference in serum N-MID level between the two groups before and after treatment ( P＞0. 05). Conclusion Alendronate combined with Xianlinggubao was safe and effective in the treatment of osteoporotic proximal humerus fractures in elderly patients. It could effectively relieve pain, accelerate fracture healing, improve the shoulder function of patients and reduce the complications incidence after treatment, thus is worthy of clinical promotion.