全髋关节置换术后单用与联合应用抗骨质疏松药物的疗效对比研究  

Effectiveness of single or combined application of antiosteoporosis drugs against bone mineral density loss around femoral implants after total hip arthroplasty

作　　者：高益[1] 瞿玉兴[1] 王斌[1] 周祺[1] 徐建达[1] 

机构地区：[1]南京中医药大学附属常州市中医医院骨一科,江苏常州213000

出　　处：《中国现代医学杂志》2016年第23期82-88,共7页China Journal of Modern Medicine

基　　金：常州市高层次卫生人才培养工程基金(No:2016CZBJ049)

摘　　要：目的对比研究全髋关节置换术后单用与联合应用抗骨质疏松药物对股骨假体周围骨质疏松的疗效。方法实验共纳入60例患者,随机分为单用药物(阿仑膦酸钠70 mg/周)组(18例)、联合用药(阿仑膦酸钠35 mg/周和阿法骨化醇)组(20例)、空白对照组(22例),术后1、12、24和48周利用双能X线检查假体周围骨密度(BMD)、血清骨碱性磷酸水平,以及血清Ⅰ型胶原N端肽水平,统计分析各组指标的差异。结果术后12、24和48周单用药物及联合用药组研究对象股骨距区域BMD基本稳定,高于空白对照组,差异有统计学意义(P<0.05)。术后12、24和48周单用药物及联合用药组血清Ⅰ型胶原N端肽水平低于空白对照组,差异有统计学意义(P<0.05)。结论单用阿仑膦酸钠、联合应用阿仑膦酸钠及阿法骨化醇可以有效地预防股骨假体周围骨量减少和BMD下降,尤其是在股骨距区域。联合用药可以降低阿仑膦酸钠的用量,疗效与标准计量相当。Objective To investigate the effectiveness of Alendronate monotherapy and combined therapy of Alendronate and Alfacalcidol for bone mineral density（BMD） preservation around femoral implants after primary total hip arthroplasty（THA）. Methods This study series included 60 patients who were classified into monotherapy（Alendronate alone 70 mg/w, n = 18）, combined-therapy（Alendronate 35 mg/w and Alfacalcidol,n = 20） and non-medication（n = 22） groups. The periprosthetic BMD and profile of the biochemical markers such as bone-specific alkaline phosphatase and serum N-terminal telopeptides of type 1 collagen（NTX） were measured at 1, 12, 24 and 48 weeks after surgery and compared between the groups. Results The BMD values of the region of the calcar in the monotherapy and combined-therapy groups were basically stable and significantly higher than those of the non-medication group at each measurement period（P〈0.05）. The plasma level of NTX in the monotherapy and combined-therapy groups was significantly lower than that in the nonmedication group at each measurement period（P〈0.05）. Conclusions The monotherapy and combined-therapy regimens can significantly prevent periprosthetic BMD loss around femoral implants, most notably in the calcar. The effectiveness of half-dose Alendronate in combined-therapy is similar to that of whole-dose Alendronate therapy.

关 键 词：全髋关节置换 股骨假体 抗骨质疏松 药物 

分 类 号：R687.4[医药卫生—骨科学]