唑来膦酸对骨质疏松患者全膝关节置换术后的影响

The influence of zoledronic acid on the osteoporotic patients after total knee arthroplasty

目的:分析术后使用唑来膦酸对骨质疏松患者全膝关节置换术(TKA)后的影响。方法:回顾性研究自2009年9月至2013年6月间收治的需要进行TKA患者,共有38例符合纳入标准。其中研究组18例,在行TKA后1周内静脉滴注唑来膦酸5 mg;对照组20例,使用等量的安慰剂,密切观察输液过程中的后续反应。术前、术后3个月检测其骨密度,同时记录随访过程中出现的其他部位和假体周围的新出现的骨折以及TKA术后HSS功能评分。结果:术前研究组腰椎(L2-4)、股骨远端、胫骨近端的骨密度(g/cm^2)分别为0.642±0.059,0.621±0.059,0.601±0.051;对照组分别为0.654±0.062,0.623±0.061,0.602±0.057。术后3个月研究组腰椎(L2-4)、股骨远端、胫骨近端的骨密度分别为0.785±0.078,0.797±0.064,0.757±0.063;对照组分别为0.652±0.067,0.621±0.059,0.601±0.059。2组术前、术后骨密度差异有统计学意义(P<0.05)。研究组的其他部位骨折发生率,HSS评分分别为5.56%、82.2分,对照组为20%、76.6分,2组对比差异有统计学意义(P<0.05)。结论:骨质疏松患者TKA后使用唑来膦酸安全有效,不仅降低假体周围骨折和其他部位骨折的发生率,还可以提高患者膝关节周围、腰椎骨密度,增加膝关节功能评分。

Objective： To analyze the impact of zoledronic acid on patients suffering from osteoporosis after total knee arthroplasty （TKA）. Methods： A retrospective study was conducted to 38 cases selected from patients in need of knee arthroplasty admitted from September 2009 to June 2013. Among these, 18 cases （study group） were given intravenous drip of zoledronic acid to 5 mg after knee arthroplasty; 20 cases （control group） were given the same amount of placebo, and closely observed for the subsequent reaction in infusion process. Their bone density was tested in preoperative and postoperative 3 months; meanwhile, new fractures in other parts or around prosthesis appearing during follow-up visits were recorded, as well as HSS function after surgery for TKA. Results： Bone density at the lumbar （L2-4）, distal femur and proximal tibia （g/cm2） of study group are （0.642±0.059）, （0.621±0.059） and （0.601±0.051）, respectively; these of the control group are （0.654±0.062）, （0.623±0.061） and （0.602±0.057）, respectively. Three months later, these data of study group increased to （0.785±0.078）, （0.797±0.064）, （0.757±0.063）, respectively; these data of control group respectively become （0.652±0.067）, （0.621±0.059）, （0.601±0.059）, respectively. Comparison shows that preoperative and postoperative bone mineral density of the two groups has obvious statistical significance （P〈0.05）. Moreover, fracture incidence in other parts of study group and HSS score were 5.56% and 82.2 （points）, respectively; those of the control group were 20% and 76.6 （points）. Comparison of the two groups had significant statistical significance （P〈0.05）. Conclusion： The application of zoledronic acid to patients with osteoporosis after total knee arthroplasty is safe and effective, not only reducing incidence of fractures around prosthesis and in other parts, but also improving bone density around knee joint, lumbar spine and increasing HSS score of knee joint.