PFNA术后应用动物骨多肽类药物促进骨折愈合的临床疗效研究

赵晓明; 苏晨晨; 娄啸霄; 张银刚

doi:10.16766/j.cnki.issn.1674-4152.001806

PFNA术后应用动物骨多肽类药物促进骨折愈合的临床疗效研究

doi: 10.16766/j.cnki.issn.1674-4152.001806

1.
西安交通大学第一附属医院骨科, 陕西西安 710061
2.
延安市中医院运动医学科，陕西延安 716000

基金项目:

国家自然科学基金 81371987

详细信息

通讯作者:
苏晨晨，E-mail：258267205@qq.com

中图分类号: R683.42 R687.33
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- 被引次数: 0
出版历程
- 收稿日期: 2020-08-18
- 网络出版日期: 2022-02-19

Clinical efficacy of animal bone peptides in promoting fracture healing after PFNA operation

1.
Department of Orthopedics, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China

摘要

摘要: 目的探究动物骨多肽类药物在骨折愈合方面对于行股骨近端防旋髓内钉术(proximal femoral nail antirotation，PFNA)的骨质疏松性股骨粗隆间骨折患者的临床疗效影响。方法选取2018年12月—2019年6月西安交通大学第一附属医院骨科收治的104例股骨粗隆间骨折患者，采用随机数字表法分为对照组和观察组，每组52例。2组患者均行PFNA，观察组术后应用动物骨多肽注射液继续治疗，对照组术后给予常规药物治疗以进行对比，比较2组患者术后骨折临床愈合时间、疼痛评分、髋关节功能评分、手术优良率及骨矿物质密度改善，并记录治疗过程中并发症发生率。结果 104例病例均得到随访，观察组与对照组相比，术后骨折临床愈合时间明显缩短[(11.37±1.35)周vs. (12.85±1.76)周]，术后疼痛症状的缓解程度[(0.21±0.11) vs. (0.83±0.13)]及髋关节功能恢复程度[(86.35±10.51) vs. (75.61±11.32)]也优于对照组，同时，不同部位骨密度测量值也较对照组有所提高，术后并发症的发生率也显著降低(3.8% vs. 7.7 %)，差异具有统计学意义(均P＜0.05)。结论动物骨多肽类注射液能有效地促进骨折的愈合，同时能够有效消肿止痛，缓解患者的病痛，加快术后髋关节的功能恢复，并能有效降低术后再骨折等不良并发症的发生率，是股骨粗隆间骨折行PFNA固定术后的一种良好的补充用药，值得在推广应用。
- 动物骨多肽 /
- 股骨粗隆间骨折 /
- 骨质疏松 /
- 内固定 /
- 股骨近端防旋髓内钉
Abstract: Objective To explore the effect of animal bone polypeptide injection on the postoperative fracture healing of senile osteoporosis intertrochanteric fracture after proximal femoral nail antirotation (PFNA). Methods A total of 104 senile osteoporotic femoral intertrochanteric fractures admitted to the Department of Orthopedics, the First Affiliated Hospital of Xi'an Jiaotong University from December 2018 to June 2019 were selected. According to the method of random number table, all the patients were divided into the control group (52 cases) and the observation group (52 cases). PFNA surgery was performed in both groups. Patients in the observation group used animal bone polypeptide after surgery, while patients in the control group were treated with conventional basic drug after surgery for comparison. Postoperative pain relief (VAS score), hip fracture healing, postoperative joint function recovery (Harris score), excellent and good fracture healing rate and bone mineral density deposition improvement were compared between the two groups. Adverse complications during follow-up treatment were recorded and the rate was calculated. Results All 104 cases were followed up. Compared with the control group, the clinical healing time of postoperative fracture in the observation group was obviously shorter [(11.37±1.35) weeks vs. (12.85±1.76) weeks], the degree of relief of postoperative pain symptoms [(0.21±0.11) vs. (0.83±0.13)] and the degree of functional recovery of hip joint [(86.35±10.51) vs. (75.61±11.32)] in the observation group were also better than those in the control group. Meanwhile, the bone mineral density of different parts in the observation group was higher than that in the control group, and the incidence of postoperative complications was also significantly lower (3.8% vs. 7.7%), all P < 0.05). Conclusion Animal bone polypeptide drugs can effectively promote fracture healing, reduce swelling and pain, facilitate the postoperative rehabilitation of hip function, and effectively decrease adverse complications during follow-up treatment such as re-fracture and intramedullary nail loosening. It can be used as a good postoperative supplement for PFNA fixation of intertrochanteric fractures and has extensive clinical value.
- Animal bone polypeptide /
- Intertrochanteric fractures /
- Osteoporosis /
- Internal fixation /
- Proximal femoral nail antirotation

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表 1 观察组与对照组术后疼痛评分比较 (x±s，分)

组别	例数	术后2周	术后1个月	t值	P值
观察组	52	0.62±0.17	0.21±0.11	5.721	＜0.001
对照组	52	1.27±0.25	0.83±0.13	3.265	0.009
t值		-8.265	-10.052
P值		0.017	＜0.001

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表 2 2组患者术后髋关节功能评分及骨折愈合优良率情况比较 (例)

组别	例数	优	良	中	差	Harris评分(x±s)	优良率(%)
观察组	52	42	7	3	0	86.35±10.51	94.23
对照组	52	31	14	5	2	75.61±11.32	86.54
统计量						9.022^a	7.375^b
P值						＜0.001	0.018
注：^a为t值，^b为χ²值。

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表 3 2组患者术后骨密度值比较 (x±s，g/cm²)

组别	例数	健侧股骨	腰椎	大转子	Ward三角
观察组	52	0.54±0.07	0.63±0.07	0.41±0.06	0.38±0.05
对照组	52	0.45±0.04	0.51±0.03	0.32±0.05	0.33±0.07
t值		2.682	3.022	3.550	2.865
P值		0.025	＜0.001	0.009	0.028

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表 4 2组患者术后并发症发生率比较 (例)

组别	例数	髋内翻	松动	退钉	再发骨折	骨折端移位	并发症发生率(%)
观察组	52	1	1	0	0	0	3.8(2/52)
对照组	52	1	1	1	1	1	7.7(4/52)
注：2组并发症发生率比较，χ²=9.624，P＜0.001。对照组中1名患者同时出现2种并发症。

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参考文献(21)

[1]	许汉权, 李彩华. 老年骨质疏松性粗隆间骨折的治疗[J]. 广东医学, 2018, 39(20): 3051-3054. doi: 10.3969/j.issn.1001-9448.2018.20.012
[2]	刘文斌. 老年股骨粗隆间骨折应用PFNA联合PFN内固定治疗临床效果观察[J]. 河北医学, 2019, 25(4): 629-633. doi: 10.3969/j.issn.1006-6233.2019.04.027
[3]	孙宝慧, 黄兴. 老年股骨粗隆间骨折PFNA术与人工股骨头置换术治疗效果比较[J]. 现代医药卫生, 2018, 34(15): 2372-2374. doi: 10.3969/j.issn.1009-5519.2018.15.035
[4]	黄超宇, 朱国华, 李裕汉. PFNA治疗股骨粗隆骨折的效果与并发症[J]. 中国伤残医学, 2017, 25(13): 4-6. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201796054.htm
[5]	马晓红, 刘斌钰, 谷青芬, 等. 接骨片联合动物多肽促进骨折愈合的临床疗效观察[J]. 山西大同大学学报(自然科学版), 2019, 35(6): 49-51, 55. doi: 10.3969/j.issn.1674-0874.2019.06.016
[6]	刘嵬, 张英剑. 影像学评价骨折愈合的研究进展[J]. 医学信息, 2018, 31(24): 48-51, 81. doi: 10.3969/j.issn.1006-1959.2018.24.013
[7]	张煜卓, 王成. 早期康复路径对髋关节置换术患者恢复进程和Harris评分的影响[J]. 实用临床医药杂志, 2020, 24(7): 129-132. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202007037.htm
[8]	张立海. 老年骨质疏松骨折的现状和挑战[J]. 中华老年多器官疾病杂志, 2020, 19(7): 481-484. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLQG202007002.htm
[9]	王春, 王永刚, 周利均, 等. 不同手术方法治疗股骨转子间骨折的疗效对比[J]. 浙江创伤外科, 2020, 25(2): 229-231. doi: 10.3969/j.issn.1009-7147.2020.02.013
[10]	郭军芳, 肖义陂, 许振波, 等. 高龄股骨粗隆间骨折的PFNA治疗[J]. 江西医药, 2018, 53(8): 834-836. doi: 10.3969/j.issn.1006-2238.2018.8.017
[11]	戚文元, 黄晓东, 张超群. 不同内固定手术治疗老年股骨粗隆间骨折的临床对照研究[J]. 创伤外科杂志, 2018, 20(12): 923-925. doi: 10.3969/j.issn.1009-4237.2018.12.013
[12]	侯永洋, 庞施义, 薛伟美, 等. 高龄股骨粗隆间骨折PFNA内固定术后早期并发症分析[J]. 中国骨与关节损伤杂志, 2017, 32(3): 323-325. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201703039.htm
[13]	李兴艳, 张津明, 鲍远, 等. 髓内、外内固定与人工关节置换术治疗高龄股骨粗隆间骨折疗效对比研究[J]. 中国骨与关节损伤杂志, 2016, 31(10): 1030-1033. doi: 10.7531/j.issn.1672-9935.2016.10.007
[14]	王建芳, 邓凤云. 鹿瓜多肽注射液的临床应用研究进展[J]. 临床合理用药杂志, 2019, 12(19): 177-179. https://www.cnki.com.cn/Article/CJFDTOTAL-PLHY201919104.htm
[15]	崔晓忠, 卢致顺, 戚磊京. 鹿瓜多肽促进骨折愈合的临床观察[J]. 临床和实验医学杂志, 2006, 5(7): 954-955. doi: 10.3969/j.issn.1671-4695.2006.07.075
[16]	周绮红. 鹿瓜多肽中骨诱导多肽类生物因子在临床中应用[J]. 中国伤残医学, 2017, 25(18): 100.
[17]	赵广跃, 朱庆生, 吕宏升. 鹿瓜多肽注射液治疗四肢骨干骨折的临床观察[J]. 中国骨与关节损伤杂志, 2005, 8(20): 537-538. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS200508017.htm
[18]	蒲卉明, 赵凌艳, 程建明, 等. 温针灸配合穴位注射鹿瓜多肽注射液治疗类风湿性关节炎的临床研究[J]. 世界中医药, 2016, 11(4): 711-714. doi: 10.3969/j.issn.1673-7202.2016.04.038
[19]	蔡俊, 郑光磊, 沈晓强, 等. 鹿瓜多肽及骨髓基质干细胞经股动脉注入治疗骨折不愈合的实验研究[J]. 浙江医学, 2019, 41(22): 2384-2388. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJYE201922011.htm
[20]	闻琴, 张催, 何岚, 等. 鹿瓜多肽注射液治疗骨质疏松性骨折疗效观察[J]. 实用中医药杂志, 2016, 32(11): 1133-1134. doi: 10.3969/j.issn.1004-2814.2016.11.074
[21]	赵正旭, 郝毅, 茹选良. 鹿瓜多肽注射液治疗原发性骨质疏松症疗效观察[J]. 中国骨与关节损伤杂志, 2006, 21(6): 500-501. doi: 10.3969/j.issn.1672-9935.2006.06.047