降钙素联合手术治疗老年骨质疏松性桡骨远端不稳定性骨折疗效

摘要

Objective To observe the efficacy of calcitonin combined with operation for the treatment of unstable distal radial fractures in elderly patients with osteoporosis.Methods From Jan.2009 to Dec.2011,80 elderly patients with unstable distal radial fracture were randomly divided into two groups:the research group and the control group.Both groups were operated with volar locking compression plate fixation.Patients in the research group were treated with calcitonin dose of 50IU that was added to 100IU after 2 weeks,and caltrate D600 daily after operation,while patients in the control group were treated with caltrate D600 only.The drug administration time was three months in both groups.Bone healing was assessed with X ray and bone mineral density(BMD)was measured by dual energy X-ray absorptiometry.Modified Sarmiento scales,Mcbride scores,complications,adverse drug effect and subsequent fractures were recorded postoperatively.Results All patients were followed up for an average of 12 months.The modified Sarmiento scale showed excellent in 27 cases and good in 13 cases in the research group, while excellent in 23 cases and good in 17 cases in the control group.Wrist function was evaluated with modified Mcbride system,which showed excellent in 25 cases,good in 11 cases,and fair in 4 cases in the research group, while excellent in 13 cases,good in 19 cases,and fair in 9 cases in the control group.No significant difference was found between the two groups in BMD preoperatively(P >0.05).The changes in BMD were significantly different between the two groups after 6 months and 12 months after surgery(P <0.01).Conclusion Volar locking com-pression plate combined with calcitonin is an effective method for the treatment of unstable distal radial fractures in osteoporotic patients.It can enhance the internal fixation,promote bone healing,and improve the wrist function.%目的：观察降钙素联合手术治疗老年骨质疏松性桡骨远端不稳定性骨折术后疗效。方法80例桡骨远端背侧不稳定性骨折患者，随机分为研究组（40例）及对照组（40例），均采用掌侧锁定加压钢板手术治疗，术后研究组给予肌注降钙素50IU（2周后增加到100IU）及口服钙尔奇 D600抗骨质疏松治疗，对照组仅口服钙尔奇 D600，两组药物给予时间均为3个月。术后观察骨折愈合情况，测量左髋关节骨密度，记录患者改良的 Mcbride 腕关节功能评价标准、手术相关并发症、药物不良反应及其他部位骨折等情况。结果所有病例获得随访，随访时间12个月，改良的 Sarmiento 影像学评分：研究组优27例，良13例；对照组优23例、良17例。改良的 Mcbride 腕关节功能评分：研究组优25例、良11例、可4例；对照组优13例、良19例、可 9例。两组骨密度术前比较无差异（P ＞0．05），术后6、12个月时骨密度比较差异显著（P ＜0．01）。结论掌侧锁定加压钢板联合使用鲑鱼降钙素抗骨质疏松治疗可有效治疗骨质疏松患者桡骨远端不稳定性骨折，进一步加强内固定效果，促进骨折愈合，提高腕关节功能。