胰岛素在2型糖尿病患者股骨转子间骨折治疗中的作用

发布时间：2018-11-08 19:10

【摘要】：目的探讨胰岛素在2型糖尿病患者股骨转子间骨折治疗中的作用。方法选择2012年1月—2014年6月于上海交通大学医学院附属新华医院崇明分院30例首次诊断为2型糖尿病的股骨转子间骨折患者,年龄58~82岁,根据是否进行胰岛素治疗,将其随机分为胰岛素组和非胰岛素组,每组15例。术后3个月内每2周门诊随访1次,3个月至1年内每3个月门诊随访1次,1年后每半年门诊随访1次。观察并比较两组患者的术前准备时间、临床愈合时间、扶拐下地时间,术后2个月的骨密度指标(L1、股骨颈、华氏三角区各点骨密度)、骨代谢指标(血钙、骨钙素),术后并发症发生情况和髋关节Harris评分。结果胰岛素组的术前准备时间、临床愈合时间和扶拐下地时间均显著短于非胰岛素组(P值均0.05);胰岛素组术后2个月的L1、股骨颈、华氏三角区各点骨密度,以及骨钙素水平均显著高于非胰岛素组(P值均0.05);两组间血钙水平的差异无统计学意义(P0.05)。30例患者均获随访,随访时间12~20个月,平均为(18.8±5.6)个月。两组术后均无防旋刀片切出股骨头,无髋内翻畸形愈合,无股骨头坏死,无刀片、主钉断裂发生。两组间术后3、6、12个月的髋关节Harris评分的差异均无统计学意义(P值均0.05)。结论对于2型糖尿病合并股骨转子间骨折行手术治疗的老年患者,胰岛素干预治疗可有效缩短术前准备时间,促进骨折的愈合,且可增强骨强度,但仍需结合其他抗骨质疏松治疗,疗效才能更佳。
[Abstract]:Objective to investigate the role of insulin in the treatment of intertrochanteric fracture of femur in type 2 diabetes mellitus. Methods from January 2012 to June 2014, 30 patients with intertrochanteric fracture of femur, aged 58 to 82 years, who were diagnosed as type 2 diabetes for the first time, were selected from Chongming Branch, affiliated Xinhua Hospital, Shanghai Jiaotong University, according to whether they were treated with insulin or not. They were randomly divided into insulin group (n = 15) and non insulin group (n = 15). The patients were followed up once every 2 weeks in 3 months, once every 3 months in 3 months to 1 year, and once every half year after one year. To observe and compare the preoperative preparation time, clinical healing time, recovery time, bone mineral density index (L1, femoral neck, Fahrenheit triangle area BMD), bone metabolism index (blood calcium, osteocalcin) 2 months after operation. Postoperative complications and hip Harris score. Results the preoperative preparation time, the clinical healing time and the time of abscission in insulin group were significantly shorter than those in non-insulin group (P < 0.05). The bone mineral density (BMD) and osteocalcin level in insulin group were significantly higher than those in non-insulin group 2 months after operation (P < 0.05). There was no significant difference in serum calcium level between the two groups (P0.05). 30 patients were followed up for 12 ~ 20 months with an average of (18.8 卤5.6) months. There was no anti-rotation blade cutting out femoral head, no coxa varus malunion, no necrosis of femoral head, no blade and main nail fracture. There was no significant difference in hip joint Harris score between the two groups at 6 and 12 months postoperatively (P < 0. 05). Conclusion for the elderly patients with type 2 diabetes mellitus complicated with femoral intertrochanteric fracture, insulin intervention therapy can effectively shorten the preoperative preparation time, promote fracture healing, and enhance bone strength. But still need to combine other anti-osteoporosis treatment, the curative effect can be better.
【作者单位】：上海交通大学医学院附属新华医院崇明分院骨科;上海交通大学医学院附属新华医院骨科;
【分类号】：R587.1;R687.3

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