股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈骨折BTMs及预后的影响  

Effect of femoral calcar cerclage fixation combined with alendronate sodium on bone turnover markers and prognosis of osteoporotic femoral neck fractures

作　　者：卢爱民 周正新[2] 龙大伟 尹君 李春峰 LU Aimin;ZHOU Zhengxin;LONG Dawei(First Clinical Medical College,Anhui University of Chinese Medicine,Anhui,Hefei 230000,China;不详)

机构地区：[1]安徽中医药大学第一临床医学院,合肥市230000 [2]安徽省中医院 [3]安徽中医药大学附属太和中医院

出　　处：《河北医药》2024年第6期826-829,834,共5页Hebei Medical Journal

基　　金：安徽省自然科学基金面上项目(编号:2008085MH281);阜阳市科技局科技计划项目(编号:FK202081110);安徽中医药大学临床科研项目(编号:2021LCTH26)。

摘　　要：目的观察“糖果钢丝”环扎术对股骨距环扎固定联合阿仑膦酸钠对骨质疏松性股骨颈基底部骨折骨转换生化标志物(bone turnover markers,BTMs)及预后的影响。方法筛选2019年5月至2022年5月符合纳入标准的64例骨质疏松性股骨颈基底部骨折患者,随机分为观察组和对照组,每组32例。对照组予以股骨头置换术,术后连续服用碳酸钙D3片3个月;观察组在对照组的基础上予以股骨距“糖果钢丝”环扎固定术,术后连续服用阿仑膦酸钠片3个月。比较2组手术时间、术中出血量、手术切口长度、开始下地时间、住院时间,并分别比较治疗前和治疗3个月后2组患者假体周围骨密度(bone mineral density,BMD)、血清Ⅰ型原胶原N-端前肽(serum N-terminal peptide of type Ⅰ collagen,S-PINP)、血清Ⅰ型胶原C-末端肽交联(serum C-terminal telopeptide of type Ⅰ collagen,S-CTX);并随访12个月分析患者术后Harris髋关节功能评分、疼痛视觉模拟评分(visual analogue scale,VAS)、改良Barthel指数(modified Barthel index,MBI)评分改善情况及术后并发症发生情况。结果2组患者手术时间、术中出血量、切口长度比较无显著差异(P>0.05),2组患者术后开始下地时间和住院时间比较观察组显著低于对照组(P<0.05)。2组骨转换生化标志物S-PINP和S-CTX均较术前升高,但观察组骨形成生化标志物S-PINP显著高于对照组,骨吸收生化标志物S-CTX显著低于对照组,差异有统计学意义(P<0.05)。2组假体周围BMD均较治疗前升高,且观察组显著高于对照组,差异有统计学意义(P<0.05)。随访12个月时Harris评分、BMI评分均较术前提高,且观察组显著高于对照组,VAS评分均较术前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05)。术后随访期间观察组并发症发生率低于对照组,但差异无统计学意义(P<0.05)。结论“糖果钢丝”环扎技术联合阿仑膦酸钠可以有效改善骨质疏松性�Objective To observe the effect of“candy wire”cerclage fixation on bone turnover markers(BTMs)and prognosis in osteoporotic femoral neck basal fractures treated with femoral calcar cerclage fixation combined with alendronate sodium.Methods From May 2019 to May 2022,a total of 64 eligible patients with osteoporotic femoral neck basal fractures were selected and randomly divided the observation group and control group,with 32 cases per group.Patients in both groups were managed by femoral head replacement surgery and oral medication of calcium carbonate D3 tablets for 3 months after the surgery,and those in the observation group were additionally treated with the“candy wire”fixation procedure for the femoral calcar and continued to take alendronate sodium tablet for 3 months after the surgery.The operation time,intraoperative blood loss,length of surgical incision,time to off-bed activities,and hospital stay were compared between the two groups.The bone mineral density(BMD),serum N-terminal peptide of type Ⅰ collagen(S-PINP),and serum C-terminal telopeptide of type Ⅰ collagen(S-CTX)were compared between the two groups before and after 3 months of treatment.Patients were followed up for 12 months to analyze the improvement of the Harris Hip Scale(HHS)scores,the Visual Analog Scale(VAS)scores,the modified Barthel index(MBI),and postoperative complications.Results There were no significant differences in operation time,intraoperative bleeding,and length of surgical incision between groups(P>0.05).The time to off-bed activities and hospital stay were significantly shorter in the observation group than those of the control group(P<0.05).BTMs of S-PINP and S-CTX increased significantly after the surgery in both groups compared with those before surgery.The bone formation marker of S-PINP in the observation group was significantly higher than that of the control group,and the bone resorption marker of S-CTX was significantly lower than that of the control group(P<0.05).The BMD around the prostheses significant

关 键 词：股骨颈骨折 股骨头置换术 “糖果钢丝”环扎术 骨质疏松性 骨转换 预后 股骨距 

分 类 号：R683.42[医药卫生—骨科学]