Li Yong, Zhao Wen-Bo, Wang De-Li, He Qing, Li Qin, Pei Fu-Xing, Liu Lei
Department of Orthopedics, Navy General Hospital of PLA, Bejing, China.
Chin J Traumatol. 2016 Oct 1;19(5):259-263. doi: 10.1016/j.cjtee.2016.07.001.
To observe the clinical results of proximal femoral nail anti-rotation (PFNA) combined with zoledronic acid injection in the treatment of osteoporotic intertrochanteric fractures in the elderly.
60 elderly patients with osteoporotic intertrochanteric fractures were diagnosed using a dual energy X-ray bone density instrument. Patients were randomly divided into treatment or control groups (30 cases in each group). Patients in both groups were treated by closed/open reduction and internal fixation using PFNA. In the treatment group, patients received one zoledronic phosphonic acid injection of 5 mg/100 ml via intravenous drip, in addition to 600 mg of Caltrate D (qd) and 0.25 mg of alpha ossification alcohol (qd). The control group received 600 mg of Caltrate D (qd) and 0.25 mg of alpha ossification alcohol (qd). The oral drugs were administered for 12 months. Bone pain relief was observed, and changes in the bone mineral density (BMD) of the lumbar and health-side hip were recorded. Clinical results were evaluated using the Visual Analogue Scale (VAS), Harris joint function score, and Osteo- porosis Quality of Life Scale (OQOLS).
Compared with the control group, bone pain symptoms were significantly alleviated (p < 0.05) in the treatment group. In the treatment and control groups, both between-group and within-group differences in BMD were significantly increased in L1e4, femoral neck and trochanter (p < 0.05). No significant differences were found between the two groups in regard to the involved hip or the total rate of improvement at the end of the follow-up period, although cases in the treatment group had higher OQOLS scores than those of the controls (p = 0.04). Cases in the treatment group healed more quickly than those in the control group [(13 ± 3.2) weeks vs (15 ± 4.6) weeks, p = 0.02]. During the follow-up period, cases in the treatment group had no new fractures, whereas 2 new cases of hip fracture and 2 cases of distal radial fractures were observed among the controls.
Zoledronic acid injection combined with PFNA is a favorable treatment option for the elderly patients with osteoporotic intertrochanteric fracture. It can effectively relieve bone pain, increase bone density, improve quality of life, reduce the occurrence of new fractures and promote fracture healing.
观察股骨近端防旋髓内钉（PFNA）联合唑来膦酸注射液治疗老年骨质疏松性股骨转子间骨折的临床效果。
采用双能X线骨密度仪诊断60例老年骨质疏松性股骨转子间骨折患者。将患者随机分为治疗组和对照组（每组30例）。两组患者均采用PFNA进行闭合/切开复位内固定治疗。治疗组患者除口服600mg钙尔奇D（每日1次）和0.25mg阿法骨化醇（每日1次）外，还静脉滴注1次5mg/100ml唑来膦酸。对照组口服600mg钙尔奇D（每日1次）和0.25mg阿法骨化醇（每日1次）。口服药物服用12个月。观察骨痛缓解情况，记录腰椎和健侧髋部的骨密度（BMD）变化。采用视觉模拟评分法（VAS）、Harris关节功能评分和骨质疏松生活质量量表（OQOLS）评估临床效果。
与对照组相比，治疗组骨痛症状明显缓解（p<0.05）。治疗组和对照组L1~4、股骨颈和转子间的组间及组内BMD差异均显著增加（p<0.05）。随访期末，两组患髋或总体改善率无显著差异，尽管治疗组的OQOLS评分高于对照组（p = 0.04）。治疗组患者骨折愈合较对照组更快[（13±3.2）周对（15±4.6）周，p = 0.02]。随访期间，治疗组患者未出现新发骨折，而对照组观察到2例髋部新发骨折和2例桡骨远端骨折。
唑来膦酸注射液联合PFNA是治疗老年骨质疏松性股骨转子间骨折的良好选择。它能有效缓解骨痛，增加骨密度，改善生活质量，减少新发骨折的发生并促进骨折愈合。
