标题：PTH联合LFPEF对老年股骨粗隆间骨折PFNA术后髋关节功能和预后的影响

      作者：林伟龙，李平生，龚骏    中国人民解放军第九五医院骨一科，福建 莆田 351100

      卷次： 2019年30卷4期

      【摘要】 目的 探究甲状旁腺激素(PTH)联合低频脉冲电磁场(LEPEF)对老年股骨粗隆间骨折患者防旋股骨近端髓内钉内固定术(PFNA)后髋关节功能及预后的影响。方法 回顾性分析2016年2月至2018年4月在中国人民解放军第九五医院骨一科接受PFNA内固定手术治疗的107例老年股骨粗隆间骨折患者的临床资料，按照手术方式的不同将其分为观察组56例和对照组51例。对照组患者于PFNA术后采用PTH治疗，观察组患者则在上述基础上联合LFPEF治疗，治疗时间均为 6个月。术前、治疗 1周后、2周后、4周后、8周后采用视觉模拟疼痛评分(VAS评分)比较两组患者的髋关节疼痛程度，并于术前、治疗1个月后、3个月后、6个月后采用Harris评分对两组患者的髋关节功能进行量化评价，统计两组患者的骨折愈合时间。同时在术前、治疗后对两组患者的术侧股骨颈、股骨大粗隆以及Ward三角区骨密度水平进行比较。结果 术前，两组患者的VAS评分比较差异无统计学意义(P>0.05)；观察组患者在治疗1周后、2周后、4周后、8周后的VAS评分分别为(6.12±0.45)分、(5.45±0.41)分、(4.04±0.38)分、(1.13±0.17)分，明显低于对照组的(6.86±0.63)分、(6.03±0.56)分、(4.71±0.43)分、(1.48±0.21)分)，差异均有统计学意义(P<0.05)；治疗1个月后、3个月后、6个月后，观察组患者的髋关节Harris评分分别为(71.18±7.18)分、(82.49±8.71)分、(88.03±9.11)分，均明显高于对照组的(63.29±6.33)分、(74.55±6.56)分、(82.14±7.04)分，其骨折愈合时间为(11.19±0.54)周，也明显少于对照组的(13.86±0.71)周，差异均有统计学意义(P<0.05)；术前，两组患者的股骨颈、股骨大粗隆以及Ward三角区的骨密度水平比较差异均无统计学意义(P>0.05)；治疗6个月后，观察组患者的股骨颈、股骨大粗隆以及Ward三角区的骨密度水平分别为(0.98±0.17) g/cm2、(0.87±0.15) g/cm2、(0.84±0.14) g/cm2，均明显高于对照组的(0.85±0.13) g/cm2、(0.76±0.11) g/cm2、(0.77±0.09) g/cm2，差异均有统计学意义(P<0.05)。结论 PFNA术后采用PTH联合LFPEF对老年股骨粗隆间骨折患者进行治疗，在有效提高骨密度的同时，还能够有效缓解髋关节疼痛，使骨量流失、骨质疏松状况得以有效改善和纠正。
      【关键词】 甲状旁腺激素；低频脉冲电磁场；老年股骨粗隆间骨折；防旋股骨近端髓内钉；复位内固定术；髋关节功能
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2019）04—455—04E

ffect of parathyroid hormone combined with low frequency pulsed electromagnetic field on hip joint functionand prognosis after PFNA in senile intertrochanter fracture of femur.
LIN Wei-long, LI Ping-sheng, GONG Jun.Department of Orthopaedics, NO.95 Hospital of the Chinese PLA, Putian 351100, Fujian, CHINA
【Abstract】 Objective To explore the effect of parathyroid hormone (PTH) combined with low frequencypulsed electromagnetic field (LFPEF) on hip joint function and prognosis after proximal femoral nail antirotation (PF-NA) in senile intertrochanter fracture of femur. Methods The clinical data of 107 elderly patients with intertrochantericfractures were retrospectively analyzed, who underwent PFNA internal fixation in the Department of Orthopaedics at theNO.95 Hospital of the Chinese PLA from February 2016 to April 2018. According to the different surgical methods, theywere divided into observation group (56 cases) and control group (51 cases). Patients in the control group were treatedwith PTH after PFNA, while patients in the observation group were treated combining with LFPEF on the above basis;both treatments lasted for 6 months. Visual Analogue Score (VAS) was used to compare the degree of hip pain betweenthe two groups before surgery, at 1, 2, 4, and 8 weeks after the treatment. The Harris score was used to quantitativelyevaluate the hip joint function of the two groups before surgery, at 1, 3 and 6 months after the treatment; and the fracturehealing time of the two groups was counted. At the same time, the bone mineral density (BMD) levels of the femo-ral neck, femoral trochanter and Ward triangle were compared between the two groups before and after the treat-ment. Results Before surgery, there was no significant difference in VAS score between the two groups (P>0.05). TheVAS scores of the observation group at 1, 2, 4 and 8 weeks after treatment were respectively 6.12±0.45, 5.45±0.41, 4.04±0.38, and 1.13±0.17, which were significantly lower than corresponding 6.86±0.63, 6.03±0.56, 4.71±0.43, and 1.48±0.21of the control group; all differences were statistically significant (P<0.05). After treatment, the Harris scores in the obser-vation group at 1, 3, and 6 months were respectively 71.18±7.18, 82.49±8.71, and 88.03±9.11, which were significantlyhigher than corresponding 63.29±6.33, 74.55±6.56, and 82.14±7.04 in the control group; and the healing time of the frac-