[1]胡光辉,刘亚峰.唑来膦酸注射液对行髋关节置换术患者骨代谢的影响[J].新乡医学院学报,2023,40(10):960-964.[doi:10.7683/xxyxyxb.2023.10.010]
　HU Guanghui,LIU Yafeng.Effect of zoledronic acid injection on bone metabolism in patients undergoing hip replacement[J].Journal of Xinxiang Medical University,2023,40(10):960-964.[doi:10.7683/xxyxyxb.2023.10.010]
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唑来膦酸注射液对行髋关节置换术患者骨代谢的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
40卷
期数:
2023年10
页码:
960-964
栏目:
临床研究
出版日期:
2023-10-05

文章信息/Info

Title:
Effect of zoledronic acid injection on bone metabolism in patients undergoing hip replacement
作者:
胡光辉1; 刘亚峰2
〔1.开封市中心医院骨科，河南　开封　475000；2.河南省洛阳正骨医院（河南省骨科医院）人工关节翻修科，河南　郑州　450000〕
Author(s):
HU Guanghui1; LIU Yafeng2
〔1.Department of Orthopedics,Kaifeng Central Hospital,Kaifeng 475000,Henan Province,China;2.Department of Artificial Joint Revision，Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital),Zhengzhou 450000,Henan Province,China〕
关键词:
唑来膦酸; 髋关节置换术; 骨代谢; 骨密度
Keywords:
zoledronic acid; hip replacement; bone metabolism; bone density
分类号:
R687.4
DOI:
10.7683/xxyxyxb.2023.10.010
文献标志码:
A
摘要:
目的　探讨唑来膦酸注射液对行髋关节置换术患者骨代谢的影响。
方法　选择2017年1月至2020年7月于开封市中心医院骨科行髋关节置换术的199例患者为研究对象，根据治疗方式将患者分为对照组（n=93）和观察组（n=106）。2组患者均行非骨水泥型全髋关节置换术，对照组患者于术后第2天口服碳酸钙D3咀嚼片，每次600 mg，每日睡前1次，连续用药2 a；观察组患者在对照组治疗基础上，分别于术后第7天及术后1、2 a各给予唑来膦酸注射液（100 mL）静脉滴注1次，滴注时间不少于15 min。于术前及术后2 a分别采集2组患者静脉血，采用酶联免疫吸附法检测血清骨代谢指标水平，包括骨吸收标志物I型胶原羧基端肽β特殊序列（β-CTX）、抗酒石酸酸性磷酸酶-5b（TRAP-5b）和骨形成标志物骨钙素（BGP）、骨特异性碱性磷酸酶（BALP）、Ⅰ型前胶原羧基末端肽（PICP）。分别于术前、术后1 a及术后2 a，采用双能 X 射线吸收测定法及Gruen分区法检测2组患者假体周围骨密度值。采用X线片测量2组患者术后2 a 股骨假体下沉距离。分别于术前及术后2 a，采用Harris髋关节评分评估2组患者的髋关节功能。
结果　术前，2组患者的血清β-CTX、TRAP-5b、BGP、BALP、PICP水平比较差异无统计学意义（P>0.05）；术后2 a，观察组患者的血清β-CTX、TRAP-5b水平显著低于对照组（P<0.05），血清BGP、BALP、PICP水平显著高于对照组（P<0.05）；2组患者术后2 a的血清β-CTX、TRAP-5b水平均显著低于术前（P<0.05），血清BGP、BALP、PICP水平均显著高于术前（P<0.05）。术前及术后1 a，2组患者的假体周围平均骨密度比较差异无统计学意义（P>0.05）；术后2 a，观察组患者的假体周围平均骨密度显著高于对照组（P<0.05）；2组患者术后1 a和术后2 a的假体周围平均骨密度均显著低于术前（P<0.05）；对照组患者术后2 a的假体周围平均骨密度显著低于术后1 a（P<0.05）；观察组患者术后1 a与术后2 a的假体周围平均骨密度比较差异无统计学意义（P>0.05）。术后2 a，对照组和观察组患者的股骨假体下沉距离分别为（0.74±0.20）、（0.57±0.21） mm；观察组患者的股骨假体下沉距离显著小于对照组（t=5.844，P<0.05）。术前，2组患者的Harris髋关节各维度评分及总评分比较差异无统计学意义（P>0.05）；术后2 a，观察组患者的Harris髋关节各维度评分及总评分均显著高于对照组（P<0.05）；2组患者术后 2 a 的Harris髋关节各维度评分及总评分均显著高于术前（P<0.05）。
结论　唑来膦酸注射液可有效改善髋关节置换术后患者的骨转换指标，抑制骨吸收和减少假体周围骨量，增加假体周围骨密度，延缓术后假体下沉，改善患者髋关节功能，值得临床推广。
Abstract:
Objective　To investigate the influence of zoledronic acid injection on bone metabolism in patients undergoing hip replacement.
Methods　A total of 199 patients who underwent hip replacement in the Department of Orthopedics,Kaifeng Central Hospital from January 2017 to July 2020 were selected as the research subjects.According to the treatment methods,the patients were divided into the control group (n=93) and the observation group (n=106).The patients in the two groups underwent cementless total hip replacement.The patients in the control group took calcium carbonate D3 chewable tablets on the second postoperative day orally,600 mg each time,once a day at bedtime for 2 years.On the basis of the treatment of the control group,the patients in the observation group were given intravenous infusion of 100 mL zoledronic acid injection on the 7th day and 1,2 years after surgery,respectively,the infusion time was not less than 15 min.Venous blood samples were collected before and 2 weeks after surgery,and the levels of serum bone metabolism indexes such as type Ⅰ collagen carboxy-terminal peptide β specific sequence (β-CTX),tartrate resistant acid phosphatase (TRAP-5b) ,and bone formation markes such as bone glaprotein (BGP),bone-specific alkaline phosphatase (BALP) and type I procollagen carboxy-terminal peptide (PICP) were detected by enzyme-linked immunosorbent assay.Before surgery,1 year and 2 years after surgery,the bone mineral density around the prosthesis of patients in the two groups was measured by dual-energy X-ray absorptiometry and Gruen partition method.The subsidence distance of the femoral prosthesis was measured by X-ray film at 2 years after surgery.Before surgery and 2 years after surgery,the hip function of patients in the two groups was evaluated by Harris hip score.
Results　There was no significant differences in serum β-CTX,TRAP-5b,BGP,BALP and PICP levels between the two groups before surgery (P>0.05);at 2 years after surgery,the levels of serum β-CTX and TRAP-5b of patiens in the observation group were significantly lower than those in the control group (P< 0.05),and the levels of serum BGP,BALP and PICP were significantly higher than those in the control group (P<0.05);the levels of serum β-CTX and TRAP-5b of patients in the two groups at 2 years after surgery were significantly lower than those before surgery (P<0.05),and the levels of serum BGP,BALP and PICP were significantly higher than those before surgery (P<0.05).There was no significant difference in the average bone mineral density around the prosthesis of patients between the two groups before surgery and 1 year after surgery (P> 0.05);at 2 years after surgery,the average bone mineral density around the prosthesis of patients in the observation group was significantly higher than that in the control group (P<0.05);the average bone mineral density around the prosthesis of patients in the two groups at 1 and 2 years after surgery was significantly lower than that before surgery (P<0.05);the average bone mineral density around the prosthesis of patients in the control group at 2 years after surgery was significantly lower than that at 1 year after surgery (P<0.05);there was no significant difference in the average bone mineral density around the prosthesis of patients in the observation group between 1 year after surgery and 2 years after surgery (P>0.05).At 2 years after surgery,the subsidence distance of femoral prosthesis of patients in the control group and the observation group was (0.74±0.20) and (0.57±0.21) mm,respectively;the subsidence distance of femoral prosthesis of patients in the observation group was significantly smaller than that in the control group (P<0.05).Before operation,there was no significant difference in the Harris hip scores of each dimension and total score of patients between the two groups (P>0.05);at 2 years after surgery,the Harris hip scores of each dimension and total score of patients in the observation group were significantly higher than those in the control group(P<0.05);the Harris hip scores of each dimension and total score of patients in the two groups at 2 years after surgery were significantly higher than those before surgery(P<0.05).
Conclusion　Zoledronic acid injection can effectively improve the bone turnover index of patients after hip replacement,inhibit the bone absorption and decrease the bone mass around the prosthesis,increase the bone density around the prosthesis,delay the sinking of the prosthesis,and improve the hip joint function of patients,which deserves to be promoted in clinical practices.

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更新日期/Last Update: 2023-10-05