Zhao Weidong, Chen Shengbao, Tang Chao, Zhang Changqing
Department of Orthopaedics, General Hospital of Ningxia Medical University, Yinchuan, China.
Department of Orthopaedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Surg J (N Y). 2024 Feb 12;10(1):e11-e19. doi: 10.1055/s-0044-1779681. eCollection 2024 Jan.
This research aimed to discern the effects of antiosteoporosis medication on postoperative functional recovery, refracture incidence, complications, and mortality in geriatric patients with intertrochanteric fractures. A retrospective study was conducted on 250 patients aged 65 years and above who underwent surgery for intertrochanteric fractures between January 2013 and December 2014. Intertrochanteric fracture is diagnosed with International Classification of Diseases 10th Revision code (S72.101) and classified by the Evans-Jensen system. Collected data encompassed demographic details, pre- and postoperative histories of antiosteoporotic medication, functional outcomes (measured using Harris hip score, Parker Mobility Score, and EuroQol-5 Dimension [EQ-5D] scores), refracture incidences, complications, and survival rates. The antiosteoporotic regimen was categorized into essential (calcium, vitamin D) and advanced medications (bisphosphonate, calcitonin, etc.). Outcomes between patients on antiosteoporosis treatment (AO group) and those without (control group) were compared. The cohort comprised 250 patients, with a gender distribution of 85 males (34%) and 165 females (66%), and a mean age of 79.8 ± 7.0 years. The median follow-up period was 15.82 months (maximum 31.13 months). Postoperatively, 126 (50.4%) patients were administered antiosteoporotic treatment. The refracture incidence in the AO group (2.4%, = 3) was notably lower than the control group (8.9%, = 11), manifesting a substantial risk reduction (odds ratio 0.251, 95% confidence interval 0.068-0.920, = 0.024). While no marked differences in functional outcomes between the AO and control groups were observed (Harris score [96.17 ± 7.77 vs. 97.29 ± 6.74, = 0.074), Parker score [8.54 ± 1.26 vs. 8.62 ± 1.18, = 0.411], EQ-5D [0.83 ± 0.05 vs. 0.82 ± 0.06, = 0.186]), patients administered a combination of essential and advanced drugs showcased significantly improved Harris and EQ-5D scores compared to those on essential drugs alone (Harris score [77.93 ± 2.04 vs. 84.94 ± 2.73, = 0.015], EQ-5D [0.65 ± 0.03 vs. 0.75 ± 0.04, = 0.015]). Postoperative antiosteoporosis treatment acts as a deterrent against refracture following intertrochanteric fracture surgeries, evidenced by a decline in refracture rates. However, the treatment's impact on functional recovery, quality of life, complications, and mortality remains indistinct. Interestingly, the combined administration of essential and advanced antiosteoporotic drugs seems to foster enhanced functional outcomes, warranting further exploration in future studies.
本研究旨在探讨抗骨质疏松药物对老年股骨转子间骨折患者术后功能恢复、再骨折发生率、并发症及死亡率的影响。
对250例年龄在65岁及以上、于2013年1月至2014年12月期间接受股骨转子间骨折手术的患者进行了一项回顾性研究。股骨转子间骨折采用国际疾病分类第10版编码（S72.101）进行诊断，并根据Evans-Jensen系统进行分类。收集的数据包括人口统计学细节、抗骨质疏松药物的术前和术后用药史、功能结局（使用Harris髋关节评分、Parker活动评分和欧洲五维健康量表[EQ-5D]评分进行测量）、再骨折发生率、并发症和生存率。抗骨质疏松治疗方案分为基础药物（钙、维生素D）和进阶药物（双膦酸盐、降钙素等）。比较了接受抗骨质疏松治疗的患者（AO组）和未接受治疗的患者（对照组）的结局。
该队列包括250例患者，性别分布为85例男性（34%）和165例女性（66%），平均年龄为79.8±7.0岁。中位随访期为15.82个月（最长31.13个月）。术后，126例（50.4%）患者接受了抗骨质疏松治疗。AO组的再骨折发生率（2.4%，n=3）显著低于对照组（8.9%，n=11），风险显著降低（比值比0.251，95%置信区间0.068-0.920；P=0.024）。虽然AO组和对照组在功能结局方面未观察到显著差异（Harris评分[96.17±7.77 vs. 97.29±6.74，P=0.074]、Parker评分[8.54±1.26 vs. 8.62±1.18，P=0.411]、EQ-5D评分[0.83±0.05 vs. 0.82±0.06，P=0.186]），但与仅使用基础药物治疗的患者相比，联合使用基础药物和进阶药物治疗的患者在Harris评分和EQ-5D评分上有显著改善（Harris评分[77.93±2.04 vs. 84.94±2.73，P=0.015]、EQ-5D评分[0.65±0.03 vs. 0.75±0.04，P=0.015]）。
术后抗骨质疏松治疗可降低股骨转子间骨折手术后的再骨折发生率。然而，该治疗对功能恢复、生活质量、并发症和死亡率的影响仍不明确。有趣的是，联合使用基础药物和进阶抗骨质疏松药物似乎能促进功能结局的改善，值得在未来的研究中进一步探索。
