Therapeutic effect of proximal femoral nail antirotation treatment combined with risedronate sodium on intertrochanteric fractures in elderly patients / 中华老年医学杂志

ABSTRACT

Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with risedronate sodium and isolated PFNA for the treatment of intertrochanteric fractures in elderly patients.Methods Clinical data of 62 elderly patients with intertrochanteric fracture from January 2011 to April 2013 were prospectively studied.Patients were randomly divided into two treatment groupsrisedronate sodium group (the combined PFNA and risedronate) and control group (isolated PFNA).According to AO classification,32 patients in risedronate sodium group (15 males and 17 females,with an average age of 78 years) were divided into type A1 (n=10),type A2 (n=18) and type A3 (n=4).30 patients in control group (13 males and 17 females,with an average age of 77.5 years) were divided into type A1 (n=9),type A2 (n=16) and type A3 (n=5).Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry before and 1 year after operation.The hip joint function was assessed by Harris hip score.Complications and subsequent fragility fractures were evaluated postoperatively.Results 60 patients (30 patients in risedronate sodium group and 30 patients in control group) were followed up for at least one year.All fractures were healed at 6 months after surgery.No significant difference was found between the two groups in BMD in contra-lateral hip before treatment [(-2.58±0.41)kg/m2 vs.(-2.56±0.36)kg/m2,P＞0.05].BMD in contra-lateral hip had significant difference between the risedronate sodium and control groups one year after surgery [(-0.66±0.37)kg/m2 vs.(-1.13 ±0.28)kg/m2,P=0.000].There was no significant difference between the two groups in Harris hip score (P=0.238).During the follow-up,no patient in risedronate group suffered from subsequent fragility fracture after surgery,while lumbar compression fracture occurred in 1 case,distal radius fracture occurred in 1 case,the contralateral hip fractures occurred in 2 cases,postoperatively.Conclusions PFNA treatment combined with risedronate sodium can effectively improve BMD and reduce the risk for refracture,and has a good effect on intertrochanteric fracture in elderly patients.