有领与无领股骨柄假体周围早期骨丢失的临床研究

The clinical study on bone loss around the femoral prosthesis with or without collar

目的:观察抗骨质疏松药及有领与无领股骨柄对全髋关节置换术后股骨侧假体周围骨密度的影响。方法:随机对80例行非骨水泥型人工髋关节假体置换患者,分成有领治疗组(1组)、对照组(2组);无领治疗组(3组)、对照组(4组),每组20例。1、3组均给予福善美+钙尔奇D3+仙灵骨葆胶囊口服,2、4组仅给口服钙尔奇D3片;各组分别于术后12d、3月、6月应用双能X线骨密度仪(DEXA)测量THA术后股骨柄假体周围的大转子(测1区)、离远端股骨柄0.5～1.0cm处股骨干(测2区)骨密度,同时测量健侧相同部位骨密度。结果:在12d和3月,1、2组相比差异无统计学意义(P>0.001)。在术后6月时,1、2组相比差异均有统计学意义(P<0.001),健侧更明显一些,说明用药能显著减少骨量流失。3、4组不论是患侧还是健侧,在术后6月时,测1区和测2区两组相比差异均有统计学意义(P<0.001)。1、3组在术后3m及6m时,不论是患侧还是健侧,各测量区骨密度比较差异均无统计学意义(P>0.05)。结论:1.使用有领柄还是无领柄对假体周围骨密度变化影响不大。2.福善美+钙尔奇D3+仙灵骨葆胶囊可预防假体周围早期骨丢失。

Objective：To observe the clinical effects of antiosteoporosis drug and prosthesis with or without collar in periprosthetic osteolysis after total hip replacement.Methods：80 patients with uncemented hip arthroplasty were randomly divided into trial group with collar（group 1）,control group（group 2）,trial group without collar（group 3） and the control group（group 4）,20 cases in each group.Group 1 and 3 received alendronate（Fosamax）,Caltrate-D and Xianlinggubao Capsule for 6 months.Group 2 and 4 received caltrate-D only.BMD of greater trochanter and femoral shaft 0.5-1.0cm below femoral stem was measured by Dual Energy X Ray Bone Densitometer at 12d,3m and 6m.BMD of contralateral side at the same place was measured too.Results：There were no significant differences in BMD between group1and group 2 at 12d and 3m（P 0.001）.6m later,there was significant difference in BMD between group1and group 2（P0.001）.It is more obvious at healthy side which shows medication can reduce the bone loss.6m later,there were significant differences between group3and group 4（P0.001） at whether the diseased side or the contralateral side.At both sides,there were no significant differences in BMD between group1and group 3 at 3m and 6m（P0.05）.Conclusion：The using of femoral prosthesis with or without collar has little influence on BMD around the prosthesis.Combined using of alendronate（Fosamax）,Caltrate-D and Xianlinggubao Capsule can prevent periprosthetic bone loss early.