2019 年第 4 期 第 14 卷

唑来膦酸对老年绝经后女性骨质疏松患者全髋关节置换术后假体周围骨密度及骨转换指标的影响

Effect of zoledronic acid on periprosthetic bone mineral density and bone turnover markers after total hip replacement in postmenopausal women with osteoporosis

作者：封江标吴良邦林宗阳

英文作者：

单位：310000杭州，解放军第一一七医院骨科

英文单位：

关键词：骨质疏松；绝经后女性；全髋关节置换术；唑来膦酸

英文关键词：

• 摘要：

• 【摘要】目的    探讨唑来膦酸对老年绝经后女性骨质疏松患者全髋关节置换术后假体周围骨密度及骨转换指标的影响。方法    选择2015年1月至2017年5月解放军第一一七医院收治的92例骨质疏松性股骨颈骨折老年绝经后女性患者，根据随机数字表法分为观察组和对照组，各46例。所有患者均行全髋关节置换术，对照组术后给予碳酸钙维生素D3片和阿法骨化醇治疗；观察组在对照组基础上给予唑来膦酸注射液治疗。观察2组患者治疗前后假体周围及腰椎骨密度、血清骨转换指标［骨碱性磷酸酶（BALP）、Ⅰ 型胶原羧基端肽（β-CTX）及骨钙素］水平及疼痛程度变化，并观察不良反应和术后1年效果。结果    治疗后6个月，观察组假体周围及腰椎骨密度均明显高于对照组［（0.655±0.212）g/cm3比（0.479±0.197）g/cm3、（0.522±0.072）g/cm3比（0.449±0.015）g/cm3］，BALP、β-CTX及骨钙素水平均明显低于对照组［（8.3±3.0）μg/L比（10.5±3.9）μg/L、（0.15±0.09）μg/L比（0.23±0.16）μg/L、（11±4）IU/L比（13±5）IU/L］（均P＜0.05）。治疗后6个月，2组疼痛视觉模拟量表评分均明显低于治疗前，且观察组明显低于对照组（均P＜0.05）。治疗过程中2组不良反应发生率比较，差异无统计学意义（P＞0.05）。术后1年，2组假体无菌性松动及假体周围骨折发生率比较，差异无统计学意义（P＞0.05）。结论    老年绝经后女性骨质疏松患者全髋关节置换术后给予唑来膦酸治疗效果显著，利于提高骨密度，改善骨转换指标，减轻骨痛，延长假体使用寿命，且安全性较高。

• 【Abstract】Objective    To evaluate the effect of zoledronic acid on periprosthetic bone mineral density and bone turnover markers after total hip replacement in postmenopausal women with osteoporosis. Methods    A total of 92 postmenopausal women with osteoporotic femoral neck fracture undergoing total hip replacement in the 117th Hospital of Chinese People′s Liberation Army from January 2015 to May 2017 were randomly divided into observation group and control group, with 46 cases in each group. The control group was treated with Calcium carbonate vitamin D3 and Alfacalcidol and the observation group was added zoledronic acid injection after operation. Periprosthetic bone mineral density(BMD), lumbar BMD, bone turnover markers［bone alkaline phosphatase（BALP）, type Ⅰ procollagen carboxyl-terminal peptide（β-CTX）, osteocalcin］, degree of pain, adverse reactions and 1-year surgical outcome were analyzed. Results    Six months after treatment, BMD levels around the prosthesis and lumbar spine in observation group were significantly higher than those in control group［（0.655±0.212）g/cm3 vs （0.479±0.197）g/cm3, （0.522±0.072）g/cm3 vs （0.449±0.015）g/cm3］; serum levels of BALP, β-CTX and osteocalcin in observation group were significantly lower than those in control group［（8.3±3.0）μg/L vs （10.5±3.9）μg/L, （0.15±0.09）μg/L vs （0.23±0.16）μg/L, （11±4）IU/L vs （13±5）IU/L］（P＜0.05）. Score of Visual Analogue Scale for pain significantly reduced after 6 months of treatment; the score in observation group was significantly lower than that in control group(P＜0.05). There was no significant difference of incidence of adverse reactions between groups(P＞0.05). One year after operation, there was no significant difference of incidences of prosthetic aseptic loosening and periprosthetic fracture between groups(P＞0.05). Conclusion    Zoledronic acid shows good safety and therapeutic effect on postmenopausal patients with osteoporosis after total hip replacement; it can effectively improve bone density, improve bone turnover indexes, reduce pain and prolong the service life of prosthesis.