Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with zoledronic acid and PFNA only in the treatment of osteoporotic intertrochanteric fracture in the elderly patients.Methods A retrospective analysis was made on 72 patients that completed the follow-up after PFNA for osteoporotic intertrochanteric fracture from November 2011 to May 2014.According to the application of zoledronic acid (5 mg,once a year) after PFNA,the patients were divided into study group (n =30) and control group (n =42).Bone healing and subsequent refracture were assessed with X-ray postoperatively.Harris hip score was recorded.Bone mineral density before operation and one year after operation were compared between the two groups.Adverse effect of zoledronic acid was recorded during hospitalization.Results Mean period of follow-up was 15 months (range,12-26 months).One year after operation,Harris score,new fracture incidence,mean fracture union time were (82.65 ± 6.24) points,3％ (1/30) and (14.26-± 2.24) weeks in study group,while (81.85 ± 5.38) points,14％ (6/42) and (15.26 ± 3.05) weeks in control group.There were no statistical differences between the two groups (P ＞ 0.05),but the subsequent fracture was higher in control group.One year after operation,lumbar and contralateral non-injury hip bone marrow density were (0.78 ± 0.16)g/cm2 and (0.71 ± 0.14)g/cm2 in study group,higher than (0.75 ± 0.13)g/cm2 and (0.69 ±0.13)g/cm2 in control group (P ＜0.05).But there were no significant differences between the two groups before operation.All fractures were healed at postoperative 1 year.No intolerable adverse events occurred in study group.Conclusions PFNA is effective in the treatment of osteoporotic intertrochanteric fracture.In the meantime,the combination with zoledronic acid has no influence on bone healing while increasing bone mineral density,and may decrease the occurrence of subsequent fragile fractures.%目的 探讨股骨近端防旋转髓内钉(PFNA)固定术后联合应用唑来膦酸治疗老年骨质疏松性股骨转子间骨折的疗效. 方法 回顾性分析2011年11月-2014年5月收治的72例骨质疏松性股骨转子间骨折患者采用PFNA固定术治疗且获得完整随访的资料,根据术后是否应用唑来膦酸(5 mg,1年1次)分为研究组和对照组两组.研究组30例采用PFNA固定术后结合唑来膦酸治疗,对照组42例采用单纯PFNA固定术治疗.术后定期随访复查X线片,观察骨折愈合和再骨折情况.采用Harris评分系统评价患者髋关节功能.通过双能X线骨密度仪分别于术前、术后1年测定腰椎和健侧髋部骨密度.住院期间记录唑来膦酸的药物不良反应. 结果 平均随访15个月(12～ 26个月).术后1年患者Harris评分、再骨折发生率及影像学骨折愈合时间,研究组分别为(82.65 ±6.24)分、3％ (1/30)、(14.26 ±2.24)周;对照组分别为(81.85 ±5.38)分、14％ (6/42)、(15.26 ±3.05)周,两组各指标比较差异均无统计学意义(P＞0.05),但对照组再骨折风险更高.术前两组腰椎和健侧髋部骨密度差异无统计学意义,术后1年腰椎和健侧髋部骨密度比较,研究组分别为(0.78 ±0.16) g/cm2、(0.71 ±0.14) g/cm2,对照组分别为(0.75±0.13) g,/cm2、(0.69±0.13)g/cm2,研究组较对照组增加(P＜0.05).术后1年两组骨折均获得影像学愈合.研究组患者未见无法耐受唑来膦酸的不良反应. 结论 对于骨质疏松性股骨转子间骨折,应用PFNA固定术具有较好疗效,结合唑来膦酸治疗能增加骨密度而不影响骨折愈合,唑来膦酸可能会减少术后再骨折风险.
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