Research Of The Bone Mineral Density, Bone Strength Indicators And Serum Bone Metabolic Markers Of Aged Patients With Intertrochanteric Fracture

PART ONE Comparation of the serum bone metabolic markers between aged patients with intertrochanteric fracture and the aged people without fractureAbstract:[Objective] To measure the biochemical markers of bone metabolism in the aged patients with intertrochanteric fracture in order to evaluate the risks of fragile hip fracture.[Methods] The mean serum levels of procollagen type I aminoterminal propeptide (PINP), cross-linked C-terminal telopeptide of type I collagen(CTX), osteocalcin(OC), parathyroid hormone(PTH) and 25(OH)D3 were measured in 142 aged patients with intertrochanteric fracture and 141 aged patients without fracture history.[Results] The mean serum levels of PINP, CTX,OC and PTH in intertrochanteric fracture group were significantly higher than that in the control group (p<0.05).No difference was found regarding 25(OH)D3 (p>0.05). [Conclusion] Serum PINP, CTX, OC and PTH levels in osteoporotic patients were positively correlated with fragile hip fracture risk. It is helpful to give those individuals appropriate osteoporosis treatment in time.PART TWO Comparation of bone mineral density and bone strength indicators between aged patients with intertrochanteric fracture and the aged people without fractureAbstract:[Objective] Comparing the bone mineral density (BMD) and bone strength indicators between aged patients with intertrochanteric fractures and patient without fractures to find probable risk factors of fractures and reliable indicators which can prevent fractures. [Methods] 66 aged patients with intertrochanteric fractures and 65 patients without fractures were classified to the fracture group and the control group. The bone mineral density was done by Dual-energy X-ray Absorbtiometry(DXA) after admission. Then bone strength indicators were calculated by the hip structure analysis (HSA).The data was statistically analyzed by SPSS18.0. [Results] The BMD and the bone strength indicators including the cross-sectional moment of inertia (CSMI), section modulus(Z score), buckling ratio(BR), cortical thickness(CT)and hip axis length(HAL) of the narrow neck and intertrochanteric region between these two groups had statistically significant difference after adjustment for age(the P value of the HAL is 0.021, the P value of each left indicator is 0.000).There was no significant difference in the neck shaft angle (NSA) between two groups(the P value is 0.127). But all the indicators lost significant difference after adjustment for BMD in each region(the P value of each indicator is greater than 0.05). Advancing age and the decreasing of BMI, section modulus and cortical thickness in the narrow neck region had significant positive correlation with intertrochanteric fractures (P values are 0.013.0.032.0.001.0.000 respectively). [Conclusion] Bone strength indicators together with BMD had important significance to predicting the risk of intertrochanteric fractures. Advancing age and the decreasing of BMI, section modulus and cortical thickness in the narrow neck region may increase the risk of intertrochanteric fractures.PART THREE Research of the perioperative serum bone metabolic markers of aged patients with intertrochanteric fractureAbstract:[Objective] Analyzing the changing trend of the perioperative serum bone metabolic markers of aged patients with intertrochanteric fractures to promote the treatment of osteoporosis and fractures. [Methods] The content of N-propeptide of type I collagen (PINP). C-terminal Telopeptides of Type I collagen(CTX)、Osteocalcin(OC). Parathyroid hormone (PTH) and25-hydroxy-vitamin D3[25(OH)D3]which was collected from the 21 aged patients with intertrochanteric fractures was measured on the next morning after admission and three months after operation respectively. The data was statistically analyzed by SPSS18.0. [Results] The postoperative content of PINP.25(OH)D3 and OC increased by75.4%.46.2% and 12.9% respectively over pre-operation, while CTX and PTH decreased by23.7% and 41.6%.The change of PINP (P=0.005) and PTH (P=0.0001) was statistically significant. [Conclusion]The serum bone metabolic markers of aged patients with intertrochanteric fractures not only reflect the bone turnover of osteoporosis but also the coupling of osteogenesis and osteoclasis in the process of fracture healing. Given the decreasing of PTH, it is necessary to inject PTH intermittently, which both can treat osteoporosis effectively and promote the healing of fractures.PART FOUR Research of the perioperative bone mineral density of aged patients with intertrochanteric fractureAbstract:[Objective] Comparing the postoperative bone mineral density(BMD) of aged patients with intertrochanteric fractures 1 day and 3 months after PFNAII internal fixation to provide theoretical basis for preventing the failure of internal fixation and recurrent fractures. [Methods] The BMD of the 40 aged patients with intertrochanteric fractures enrolled which including the healthy and the fracture hip were measured by Dual-energy X-ray Absorptiometry(DXA) 1 day after operation. The patients were required to begin functional exercise 6 weeks postoperatively and keep taking oral calcium and Vitamin D3. The BMD was measured once again for the patients who complete follow-up 3 months postoperatively. The data was statistically analyzed by SPSS18.0. [Results] Except for the interior-intertrochanteric(R3) and the lateral-intertrochanteric(R4) and the global fracture hip(RG) region, the BMD of the left part of the fracture hip (R1、R2、R5、 R6、R7、R8、 R9) had statistically significant difference. The BMD of these 7 regions had declined 6.982%,4.447%,10.483%,11.810%,8.624%,8.017% and 8.342% respectively with the order R6>R5>R7>R8>R9>R1>R2. The BMD of the healthy hip had no statistically significant difference except the Ward’s triangle region. [Conclusion] Stress-shielding after the PFNAII internal fixation may contribute to the loss of bone mineral content around the intramedullary nails. Preventing and treating osteoporosis actively and instructing patients to begin functional exercise as early as possible had important significances to preventing the failure of internal fixation and recurrent fractures.