骨水泥型Ⅰ期全髋关节置换术后假体周围骨质丢失的早期研究

Study of the periprosthetic bone loss after cemented primary total hip replacement

[目的]研究人工全髋关节置换术(THR)后假体周围的骨质丢失及假体松动的防治方法。[结果]89例骨水泥型Ⅰ期全髋关节置换的患者,分成2组,观察组47例,术后每日服用阿仑膦酸钠10 mg+钙剂600 mg;对照组42例,术后每天服用600 mg钙剂。随访12个月,测定假体周围骨矿密度及骨代谢生化指标。[结果]假体周围相同区域BMD降低不明显或升高。在股骨近端(prRO I),对照组的BMD平均降低(21.2±5.2)%,而观察组平均升高(4.2±2.6)%(P<0.05)。在随访期末两组间全假体周围(totRO I)平均BMD对照组下降了(12.1±6.2)%,而观察组升高了(2.6±1.4)%,差别有统计学意义(P<0.05)。观察组BGP明显升高(P<0.05),而对照组ACP升高(P<0.05)。[结论]阿伦膦酸钠可明显降低骨水泥型Ⅰ期全髋置换术后骨质丢失,改善骨骼对假体的支撑作用,可能会预防或延缓假体松动。

[ Objective] Periprosthetic bone loss is common after cemented total hip replacement （THR） . To study whether alendronate therapy can reduce bone loss adjacent to prostheses. [ Method ] 89 cemented primary THR patients were divided two groups. They received 10 mg alendronate ＋50 mg calcium （47 cases in observing group） or 50 mg calcium only （42 cases in contrast group） daily for 12 months follow-up after THR and Periprosthetic bone mineral density （BMD） was measured. Biochemical markers of bone metabolism in the sametime. [ Result ] In Periprosthetic BMD in the observing group was better compared with the changes in the contrast group in the same regions and at the same follow-up time. In the proximal femur （prROI）, the mean BMD decrease was （21.2 ±5.2）% in the contrast group, where as in the observing group the mean BMD increase was （4. 2 ±2.6）% （ P 〈0. 05）. The mean periprosthetic BMD changes was also significantly different in the total periprosthetic area （totROI） between the two groups at the end of the follow-up decrease （ 12. 1± 6. 2 ） % in contrast group, increase （2. 6 ± 1. 4）% in observing group （P 〈0. 05）. BGP increase in observing group （P 〈0. 05）, ACP decrease in contrast group （ P 〈 0. 05 ）. [ Conclusion ] Alendronate therapy led to a significant reduction in periprosthetic bone loss after primary cemented THR compared with the changes found in patients without therapy. This kind of bone response may improve the support of the prosthesis and may result in better survival of the prosthesis. However, in this study the follow-up time was too short and the study population was too small to make any long-term conclusion as to the prognosis for THR patients treats with alendronate.