镇痛药对骨质疏松性骨折愈合的影响  

Pain-killer affects the healing of osteoporotic fracture

作　　者：张天浩[1] 董英海[2] 俞思明[1] 张超[2] 姚兵[1] 

机构地区：[1]上海交通大学医学院附属新华医院崇明分院,上海市202150 [2]上海市交通大学医学院附属仁济医院,上海市200127

出　　处：《中国组织工程研究》2013年第35期6364-6374,共11页Chinese Journal of Tissue Engineering Research

摘　　要：背景:研究表明,非类固醇药物在镇痛的同时还可以对骨折愈合产生不利影响。然而,非类固醇抗炎药对骨质疏松性骨折愈合是否有影响国内外报道较少。目的:分别选择常用的非类固醇抗炎药双氯酚酸钠和中枢性镇痛药盐酸曲马多进行动物实验和临床观察,探讨2种药物对骨质疏松性骨折愈合的影响。方法:①动物实验:雌性SD大鼠予双侧卵巢切除后喂养3个月建立骨质疏松模型,之后行股骨中段骨折后髓内钉内固定,灌胃给药,1次/d,用药时间均为6周。随机分为4组,对照组骨折后灌注生理盐水;盐酸曲马多组骨折后灌注盐酸曲马多;双氯酚酸钠1组建立骨质疏松模型后、骨折之前灌注双氯酚酸钠;双氯酚酸钠2组骨折后灌注双氯酚酸钠。术后不同时间分别行X射线摄片及灰度值测定。②临床观察:21例骨质疏松性胸腰椎压缩性骨折患者随机分为3组,对照组6例,盐酸曲马多组(100mg/d)7例,双氯酚酸钠组(75mg/d)8例。各组予相同抗骨质疏松药物治疗并令回家卧板床修养,盐酸曲马多组、双氯酚酸钠组予1个月药物治疗。记录3组患者的疼痛目测类比评分、临床症状消失时间、骨折椎体高度变化及L_3椎体骨密度值变化。结果与结论:①动物实验结果:在第2,3周双氯酚酸钠1,2组大鼠的骨折端新生骨痂数量和密度低于其他2组,第2周X射线灰度值低于其他2组(P<0.01)。第4,6周双氯酚酸钠2组的骨折端新生骨痂数量和密度值低于其他3组,X射线灰度低于其他3组(P<0.05)。②临床观察结果:在首诊日、1、2、3周盐酸曲马多组、双氯酚酸钠组患者的目测类比评分低于对照组(P<0.01)。各组临床症状消失时间差异无显著性意义(P>0.05)。治疗后第1个月双氯芬酸钠组患者受压椎体平均灰度值及L_3椎体骨密度均低于对照组(P<0.05)。提示非类固醇抗炎药会延缓骨质疏松性骨折愈合时间,降低愈合强度,且主要影响BACKGROUND： Studies have shown that non-steroidal drugs heve analgesic effect and can also adversely affect the fracture healing. However, the effect of non-steroidal aniHnfiammatory drugs on osteoporotic fracture healing is reported less at home and abroad. OBJECTIVE： To perform the animal experiment and clinical observation with the commonly used non-steroidal anti-inflammatory drug diclofenac sodium and central inflammatory drug tramadol hydrochloride, in order to investigate the effect of pain-killer on the union of osteoporotic fracture. METHODS： Animal experiment： female rats received double side castrations and were fed for three months to make osteoporosis model. Then the rats received intramedullary nail fixation for the treatment of middle femurfracture. All drugs were applied by intragastric administration, once per day, and lasted for 6 weeks. The animals were randomly divided into four groups. The control group was injected with normal saline after fracture; tramadol hydrochloride group was injected with tramadol hydrochloride after fracture; diclofenac sodium A group was injected with diclofenac sodium before fracture and after establishment of osteoporosis model; diclofenac sodium B group was injected with diclofenac sodium after fracture. Gray value was measured by X-ray film at different time points after operation. Clinical observation： 21 patients with osteoporotic thoracolumbar vertebral compression fractures were randomly divided into three groups： control group （n=6）, tramadol hydrochloride group （n=7, 100 mg/d） and diclofenac sodium group （n=8, 75 mg/d）. All patients were treated with anti-osteoporosis drugs in the same dose and required to lie on broad bed. The patients in the tramadol hydrochloride group and diclofenac sodium group received drug treatment for 1 month. The visual analogue scale score, clinical symptoms disappeared time, vertebral height variation, and L3 vertebral bone mineral density changes were recorded. RESULTS AND CONCLUSION： Animal experimen

关 键 词：骨关节植入物 骨与关节临床实践 止痛药 骨质疏松性骨折 骨折愈合 动物实验 临床观察 内固定 盐酸曲马多 中枢性镇痛药 双氯酚酸钠 非类固醇药物 

分 类 号：R318[医药卫生—生物医学工程]