【摘要】 背景:目前关于阿仑膦酸钠与鲑鱼降钙素对骨质疏松症合并股骨转子间骨折患者的治疗效果的比较研究报道较少。目的:比较阿仑膦酸钠和鲑鱼降钙素联合加压交锁髓内钉固定治疗骨质疏松症合并股骨转子间骨折的疗效。方法:选取2018年4月至2020年8月收治的骨质疏松症合并股骨转子间骨折的老年患者76例,随机分为研究组和对照组,每组38例。对照组给予鲑鱼降钙素联合Inter Tan髓内钉治疗;研究组给予阿仑膦酸钠联合Inter Tan髓内钉治疗。记录两组患者的围手术期指标。比较两组术前、术后1个月、3个月及6个月的骨密度(腰椎、Word三角、股骨颈)、血清骨代谢指标[Ⅰ型前胶原N末端前肽(PINP)、Ⅰ型胶原交联羧基末端肽(CTX)、抗酒石酸酸性磷酸酶(TRCAP)]变化。记录术后近端骨矿含量(PBMC)、远端骨矿含量(DBMC)、不良反应及髋关节Harris评分。结果:研究组患者的住院时间、骨愈合时间显著少于对照组(P<0.05),两组的手术时间、术中出血量比较无显著差异(P>0.05)。两组术后1、3、6个月腰椎、Word三角及股骨颈骨密度呈上升趋势,组内不同时间点比较差异有统计学意义(P<0.05),且研究组术后3个月及6个月的上述指标显著高于同时间点对照组(P<0.05)。两组术后1、3、6个月的血清PINP水平呈上升趋势,TRCAP及CTX水平呈下降趋势,组内不同时间点比较差异有统计学意义(P<0.05),且研究组术后同时间点的PINP水平显著高于对照组,TRCAP水平显著低于对照组(P<0.05)。两组术后3个月的PBMC及DBMC较术后1个月均明显升高,且研究组显著高于对照组(P<0.05)。研究组术后3个月的Harris评分显著高于对照组(P<0.05);两组药物不良反应发生率无统计学差异(P>0.05)。结论:阿仑膦酸钠或鲑鱼降钙素对行Inter Tan髓内钉固定治疗的骨质疏松症合并股骨转子间骨折患者的术后干预效果良好,前者提高骨密度、促进恢复的作用更明显。更多还原

【Abstract】 Background:There are few reports on the effects of alendronate versus salmon calcitonin on osteoporosis complicated with femoral intertrochanteric fracture.Objective:To explore the efficacy of alendronate sodium versus salmon calcitonin combined with fixation using intramedullary nail on osteoporosis with femoral intertrochanteric fractures.Methods:A total of76 elderly patients with osteoporosis complicated with femoral intertrochanteric fractures who scheduled for internal fixation with InterTan intramedullary nail between April 2018 and August 2020 were randomly divided into study group and control group(n=38).Control group was given salmon calcitonin and study group was given alendronate sodium after operation.Perioperative indicators,bone mineral density(BMD) and serum bone metabolism indexes [type Ⅰ procollagen propeptide(PINP),type Ⅰ collage cross-linked-telopeptide(CTX),tartrate-resistant acid phosphatase(TRCAP)],proximal bone mineral content(PBMC),and distal bone mineral content(DBMC) were recorded.Adverse reactions and hip joint recovery were also recorded.Results:The hospital stay and bone healing time in study group were significantly shorter than those in control group(P<0.05),but there were no significant differences in surgical time or intraoperative blood loss between the two groups(P>0.05).The BMD of lumbar spine,Word triangle and femoral neck at 1,3 and 6 months after surgery showed increasing trends in both groups,with significant differences at different time points within groups(P<0.05).The above indicators in study group at 3 and 6 months after surgery were significantly higher than those in control group(P<0.05).At 1,3 and 6 months after surgery,serum PINP level showed an upward trend in both groups while serum TRCAP and CTX showed downward trends(P<0.05);study group had higher PINP level and lower TRCAP level than control group(P<0.05).PBMC and DBMC of the two groups at3 months postoperatively were significantly increased compared to those at 1 month postoperatively,and study group had higher PBMC and DBMC than control group(P<0.05).The Harris scores of study group at 3 months after surgery were significantly higher than those of control group(P<0.05).There were no statistical differences in the incidences of adverse reactions between two groups(P>0.05).Conclusions:Both alendronate and salmon calcitonin can achieve good postoperative intervention effects on elderly osteoporosis complicated with femoral intertrochanteric fractures after InterTan intramedullary nail fixation,and the former has a more obvious effect on improving bone mineral density and promoting recovery.更多还原