骨折患者长期卧床骨质改变与降钙素的预防

【摘要】 目的 探讨青壮年骨折患者长期卧床与骨量丢失、骨强度减低的关系及鲑鱼降钙素的预防作用。方法 对68 例20～35 岁严重骨折患者，36 例入院即给予鲑鱼降钙素加元素钙治疗，32 例单纯元素钙治疗，持续治疗到患者卧床结束。于入院当时及入院后1、2、3个月测量患者腰椎双能X线骨密度(bone mineral density，BMD)、胫骨超声骨强度(speed of sound，SOS)并检测血清骨钙素(bone glaprotein，BGP)、尿钙(calcium，Ca)与尿肌酐(creatinie，Cr)。将卧床超过3个月者纳入最终研究对象，其中鲑鱼降钙素加元素钙组31 例，单纯元素钙组27 例，共58 例。结果 鲑鱼降钙素加元素钙组，入院后1、2、3个月腰椎BMD与入院时相比差异均无显著性(P＞0.05)；单纯元素钙组，入院后1个月BMD无明显变化，入院后2个月与3个月BMD分别为0.765±0.191和0.598±0.187，显著(或非常显著)低于入院时(P＜0.05或P＜0.01)。胫骨中段SOS检测结果与BMD相似。两组入院后1、2、3个月血清BGP与入院时相比差异均无显著性(P＞0.05)。鲑鱼降钙素加元素钙组，入院后各时间点尿Ca/Cr比值与入院时相比差异均无显著性(P＞0.05)；单纯元素钙组，入院后1个月Ca/Cr比值无明显变化，入院后2个月与3个月尿Ca/Cr比值分别为0.853±0.434和1.011±0.546，显著(或非常显著)高于入院时(P＜0.05或P＜0.01)。结论 青壮年骨折病人长期卧床可引起骨量丢失、骨强度减低，主要由骨吸收引起，鲑鱼降钙素能预防该种骨量丢失与骨强度减低。

【关键词】 骨折；青壮年；卧床；骨密度；骨强度；鲑鱼降钙素。

Effects of Longterm bed on Loss of Bone Mass and Bone Strength and Prevention of Calcitionin in Patients with Fractures。

Abstract： Objective To probe the relationship between longterm bed and loss of bone mass and bone strength and the prevention of calcitionin in young patients with fractures. Methods There are 68 patients with severe fractures over 20～30 years old. 36 patients were treated by calcitionin＋calcium while 32 patients were treated by calcium from hospital admission to end of lying in bed. Patients were examinated by bone mineral density(BMD) of lumbar， speed of sound(SOS) of tibia， serum osteocalcin(BGP)， urinary calcium(Ca) and urinary creatinine(Cr) in admission and 1，2 and 3 months post admission. 58 patients who lay in bed over 3 months internalized into the final object. There were 31 patients were in group of calcitionin＋calcium and 27 in calcium. Results There were no significant difference in the BMD between 1，2 or 3 months postadmission and admission in the group of calcitionin＋calcium. In the group of calcium， the BMD of lumbar has not marked changes in 1 month postadmission， while that of 2 and 3 months postadmission were 0.765±0.191 and 0.598±0.187 respectively； all significantly lower than that of admission(P＜0.05 or P＜0.01). The changes SOS of tibia were similar to the BMD of lumbar. No difference was observed in BGP between 1，2 or 3 months postadmission and admission among 2 groups. The ratio of urinary Ca/Cr of 2 and 3 months postadmission were 0.853±0.434 and 1.011±0.546 respectively in the group of calcium， which significantly higher than that of admission(P＜0.05 or P＜0.01)， while no significant changes observed between 1，2 or 3 months postadmission and admission in the group of calcitionin＋calcium. Conclusion Longterm bed can cause loss of bone mass and reduction of bone strength， which mainly ascribe to bone resorption. Salmon calcitonin can prevent the change of this kind.

Key words： fracture； young； lying in bed； bone density； bone strength； salmon calcitionin。

临床骨科医生往往重视骨折患者的手术治疗，而忽略了围手术期卧床对患者骨量的丢失与骨质量(骨强度)的改变。我们通过观察青壮年骨折患者，因病情与治疗需要长期卧床引起骨量的丢失与骨强度的减低以及鲑鱼降钙素的治疗情况，以引起临床骨科医生对围手术期患者骨量丢失与骨质量改变的重视。

1 对象和方法。

1.1 对象与治疗 68 例20～35 岁严重骨折患者，其中双下肢严重多发骨折42 例，严重骨盆骨折12 例，严重脊椎骨折14 例。36 例入院即给予鲑鱼降钙素加元素钙治疗：鲑鱼降钙素50 IU肌肉注射，第1周每日1次，第2周隔日1次，以后每周2次，同时口服元素钙600 mg，每天1次；32 例单纯元素钙治疗：元素钙600 mg，每天1次，持续治疗到患者卧床结束。对因病情与治疗需要，卧床超过3个月者纳入最终研究对象，其中鲑鱼降钙素加元素钙组31 例，单纯元素钙组27 例，共58 例。

1.2 骨密度(bone mineral density，BMD)与超声骨强度(speed of sound，SOS)的测量 于入院当时及入院后1、2、3个月，运用双能X线骨密度仪测量患者腰椎(L4)BMD，运用超声骨强度仪对患者胫骨中段的SOS进行测定。

1.3 骨代谢生化指标的测定 于入院当时及入院后1、2、3个月，经自动生化分析仪测定清晨空腹尿Ca与尿Cr，计算出Ca/Cr比值，用放射免疫法测定血清骨钙素(bone glaprotein，BGP)。

1.4 统计学方法 所有数据用(±s)表示，用SPSS10.0软件进行统计分析，治疗前后同组间采用t检验。