摘要
目的探讨骨化三醇对老年股骨粗隆间骨折患者股骨近端防旋髓内钉(PFNA)内固定术后关节功能恢复及血清骨保护素(OPG)和碱性磷酸酶(ALP)水平的影响。方法回顾性分析2018年1月至2019年7月廉江市人民医院创伤骨科收治的53例行PFNA内固定术治疗的老年股骨粗隆间骨折患者的诊疗情况。按照用药方法不同分为观察组27例和对照组26例。两组患者均进行PFNA内固定术治疗,在此基础上,对照组患者采用钙尔奇D治疗,观察组患者采用骨化三醇治疗,治疗周期均为3个月。术中记录两组患者术中出血量、手术时间;术后5 d比较两组患者的行走活动能力评分、日常生活活动能力评分和视觉模拟疼痛量表(VAS)评分、血清骨保护素(OPG)水平、血清碱性磷酸酶(ALP)水平;比较两组患者的住院时间、住院费用、术后3个月的治疗效果和并发症发生情况。结果观察组患者的术后总优良率为85.19%,明显高于对照组的65.38%,差异有统计学意义(P<0.05);两组患者的术中出血量和手术时间比较差异均无统计学意义(P>0.05);观察组患者的住院时间和住院费用分别为(5.1±1.4)d、(20531.5±165.3)元,明显短(少)于对照组的(8.2±1.5)d、(24143.3±216.1)元,差异均有统计学意义(P<0.05);治疗后,两组患者的行走活动能力评分和日常生活活动能力评分均明显升高,且观察组患者的上述评分明显高于对照组,差异均有统计学意义(P<0.05);观察组患者术后24 h、48 h、72 h的VAS评分明显低于对照组,差异均有统计学意义(P<0.05);治疗前,两组患者的血清ALP、OPG水平比较差异均无统计学意义(P>0.05),而治疗后,两组患者的血清ALP、OPG水平明显升高,且观察组患者的血清ALP、OPG水平分别为(192.6±18.4)U/L、(285.5±27.4)ng/L,明显高于对照组的(172.5±17.6)U/L、(266.4±25.2)ng/L,差异均有统计学意义(P<0.05)。结论骨化三醇应用于行PFNA内固定术治疗的老年股骨粗隆间骨折患者,可有效调节患者的血清ALP、OPG水平,提高治疗效果,加快患者术后康复,具有临床应用价值。
Objective To investigate the effect of calcitriol on joint function recovery and serum osteoprotegerin(OPG)and alkaline phosphatase(ALP)levels in elderly patients with intertrochanteric fracture after proximal femoral nail antirotation(PFNA)internal fixation.Methods The clinical data of 53 elderly patients with intertrochanteric fracture treated with PFNA internal fixation from January 2018 to July 2019 were retrospectively analyzed.They were divided into an observation group(27 cases)and a control group(26 cases).Both groups were treated with PFNA internal fixation.On this basis,the control group was treated with Caltrate D,and the observation group was treated with calcitriol,with 3 months as a treatment cycle.The bleeding and operation time were recorded in the two groups during operation.The walking activity ability score,daily life activity ability score,visual analog scale(VAS)score,serum osteoprotecin(OPG)level,and serum alkaline phosphatase(ALP)level were compared 5 days after operation.The time,cost,treatment effect,and complications of the two groups were compared.Results The total excellent and good rate of the observation group was 85.19%,which was significantly higher than 65.38%of the control group(P<0.05);there was no significant difference in intraoperative blood loss and operation time between the two groups(P>0.05);the hospitalization time and expenses of the observation group were(5.1±1.4)d and(20531.5±165.3)yuan,which were significantly shorter than(8.2±1.5)d and(24143.3±216.1)yuan of the control group(P<0.05);after treatment,the walking ability scores and activities of daily living scores of the two groups were significantly increased,and the above scores of the observation group were significantly higher than those of the control group(P<0.05);the VAS scores of the observation group at 24 h,48 h and 72 h after operation were significantly lower than those of the control group(P<0.05);before treatment,there was no significant difference in serum ALP and OPG levels between the two groups(P>0.05);after treatment,the serum ALP and OPG levels of the two groups were significantly increased,and the serum ALP and OPG levels of the observation group were(192.6±18.4)U/L and(285.5±27.4)ng/L,which were significantly higher than(172.5±17.6)U/L and(266.4±25.2)ng/L of the control group(P<0.05).Conclusion Calcitriol can effectively regulate the serum ALP and OPG levels of elderly patients with intertrochanteric fracture treated by PFNA internal fixation,improve the treatment effect,and accelerate the postoperative rehabilitation of patients,which has clinical application value.
作者
温洪鹏
韩成龙
钟燕
黄科
WEN Hong-peng;HAN Cheng-long;ZHONG Yan;HUANG Ke(Department of Orthopaedics,People's Hospital of Lianjiang,Lianjiang 524400,Guangdong,CHINA)
出处
《海南医学》
CAS
2021年第10期1260-1263,共4页
Hainan Medical Journal
关键词
股骨粗隆间骨折
老年
股骨近端防旋髓内钉
手术时机
优良率
并发症
骨化三醇
Intertrochanteric fracture of femur
Elderly
Proximal femoral nail antirotation
Operation opportunity
Excellent and good rate
Complications
Calcitriol
