Objective To investigate the effects of PFNA on bone metabolism and bone strength in senile patients with inter -trochanteric fracture .Methods Fifty senile patients with intertrochanteric fracture admitted into the hospital from January 2014 to Au-gust 2015 were selected as research subjects , and were assigned as the observation group , and another 50 normal old examinees without history of bone fracture recruited from the Physical Examination Center of the hospital were selected as the control group .The patients of the observation group received PFNA treatment .Bone metabolism and bone strength indexes of the observation group were measured both before and after surgery , and bone metabolism and bone strength indexes of the control group were also detected , and then compari-sons were made between the 2 groups.Results Before surgery, the levels of PINP, PTH, CTX and OC in the observation group were significantly higher than those in the control group (P<0.05), while the level of 25(OH)D3 was significantly lower than that in the control group (P<0.05).However, after surgery, the level of serum PINP[(86.03 ±27.78)mg/L] in the observation group was sig-nificantly higher, as compared with that before surgery [(53.97 ±26.13)mg/L](P<0.05).The level of PTH[(27.67 ±11.54)ng/L] was significantly decreased, as compared with that before surgery [(51.22 ±17.65)ng/L](P<0.05), but it was slightly higher than that of the control group [(36.85 ±12.86)ng/L](P>0.05).When compared with those before surgery , no significant changes could be seen in the levels of 25(OH)D3, CTX and OC (P>0.05).Before surgery, bone strength indexes, such as the cross section rota-tion penetration amount (CSMI), bone mineral density (BMD) and the section modulus Z value (Z) of the observation group were all significantly lower than those of the control group ( P<0.05), and the buckling ratio ( BR) was significantly higher than that of the control group (P<0.05).However, after surgery, the bone strength value of the observation group was slightly decreased , as com-pared with that before surgery, but without statistical significance (P>0.05).Conclusion After PFNA treatment, bone metabolism of the patients with intertrochanteric fracture was enhanced , but bone strength was not improved .This might be associated with the small amount of peripheral bone loss due to stress shielding during surgery .With this reason, enhanced anti-osteoporosis treatment and related protective measures might be necessary for the prevention of bone fracture .%目的 探讨股骨近端防旋髓内钉手术(PFNA)治疗对老年股骨粗隆间骨折患者骨代谢和骨强度的影响.方法 选择2014年1月至2015年8月医院收治的老年股骨粗隆间骨折患者50例为观察组对象,另在医院健康体检处选择50例无骨折病史的正常老年人作为对照组,对观察组患者进行PFNA治疗,测定并比较手术前后观察组患者和对照组正常老年人的骨代谢和骨强度指标.结果 手术前,观察组患者骨代谢指标中前胶原氨基末端前肽Ⅰ型(PINP)、甲状旁腺激素(PTH)、Ⅰ型胶原羧基端肽(CTX)和血清骨钙素(OC)水平均明显高于对照组(均P<0.05),而25(OH)D3明显低于对照组(P<0.05);手术后,观察组患者血清PINP水平[(86.03±27.78)mg/L]较手术前[(53.97±26.13)mg/L]明显升高(P<0.05);PTH水平[(27.67±11.54)ng/L]较手术前[(51.22±17.65)ng/L]明显下降(P<0.05),略高于对照组[(36.85±12.86)ng/L](P>0.05),25(OH)D3、CTX和OC水平与手术前比较无明显变化(均P>0.05).手术前,观察组患者股骨粗隆间区以及股骨颈区骨强度指标中横截面转动贯量(CSMI)、骨密度(BMD)和截面模量z值(Z)均比对照组低(均P<0.05),屈曲比率(BR)明显高于对照组(P<0.05);手术后,观察组患者骨强度指标与手术前相比均稍有下降,但不具有统计学意义(P>0.05).结论 老年股骨粗隆间骨折患者经PFNA治疗后骨代谢增加,骨强度无明显改变,可能由于手术中应力遮挡作用而使髓内钉周围骨有少量丢失,需要加强抗骨质疏松治疗和防护措施以预防骨折.
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