骨质疏松对非骨水泥型人工全髋关节置换术患者近远期疗效的影响

The influence of osteoporosis on clinical curative effect of patients after the bone cementless type artificial total hip replacement

目的探讨骨质疏松对非骨水泥型人工全髋关节置换术患者术中、术后临床疗效的影响。方法选取榆林市第二医院2014年3月至2017年3月行非骨水泥型人工全髋关节置换术的髋部骨折患者136例,依据骨质疏松发生情况分为疏松组(51例)和对照组(85例),其中疏松组患者依据术后药物治疗分为替勃龙组(26例)和钙剂组(复方氨基酸螯合钙胶囊,25例),随访12周,统计分析所有患者术中失血量、引流量、手术时间和采用酶联免疫吸附试验测定血清骨碱性磷酸酶(sBAP)、骨钙素(sOC)、Ⅰ型胶原交联C端肽(sCTx),应用髋关节Harris评分评估髋关节功能,采用双能X线吸收法检测治疗前后腰椎骨密度(BMD)。结果所有患者术中失血量、引流量、手术时间比较,差异无统计意义(P>0.05);在血清sBAP、sOC、sCTx水平方面,替勃龙组患者明显优于对照组,钙剂组患者明显优于对照组,差异具有统计学意义(P<0.05);替勃龙组患者髋关节功能优良率为57.69%,钙剂组患者髋关节功能优良率为44.00%,对照组患者髋关节功能优良率为71.76%,对照组>替勃龙组>钙剂组,差异具有统计学意义(P<0.05);对照组患者12周内腰椎BMD高于替勃龙组,但差异无统计学意义(P>0.05),替勃龙组和对照组患者腰椎BMD明显高于钙剂组,差异具有统计学意义(P<0.05)。结论非骨水泥型人工全髋关节置换术后骨质疏松患者骨代谢和骨密度均差于非骨质疏松患者,髋关节功能恢复较差,术后给予替勃龙抗骨质疏松治疗可有效避免骨量的进一步丢失,值得临床作进一步推广。

Objective To investigate the influence of osteoporosis on clinical curative effect of patients with the bone cementless type artificial total hip replacement. Methods 136 patients from Yulin Second Hospital from March 2014 to March 2017 for cementless total hip arthroplasty for hip fracture were divided into osteoporosis group（ 51 cases） and control group（ 85 cases）,osteoporosis patients,according to drug therapy,were divided into tibolone group（ 26 cases） and calcium group（ 25 cases of compound calcium amino acid chelate capsule）. After 12 weeks of follow-up,intraoperative blood loss,drainage volume,operation time were compared. The enzyme-linked immunosorbent assay was used for determination of serum bone alkaline phosphatase（ sBAP） and Osteocalcin（ sOC）,type I collagen cross-linking C terminal peptide（ sCTx）.The application of hip joint Harris score was used to evaluate hip joint function,dual energy X-ray absorptiometry was used to measure lumbar bone mineral density（ BMD） before and after treatment. Results The intraoperative blood loss,operating time in osteoporosis group and the control group had no significant difference（ P 〉 0. 05）. In aspect of serum sBAP,sOC,sCTx level,drug group was obviously better than calcium group,calcium group was obviously better than control group,the difference was statistically significant（ P 〈 0. 05）. The qualified rate of hip joint function in patients with drug group was 57. 69%,calcium group 44. 00%,control group 71. 76%,control group 〉 drug group 〉 calcium group（ P 〈 0. 05）. Lumbar spine BMD in control group was higher than that in drug group,but there was no statistically significant difference（ P〉 0. 05）,lumbar spine BMD in the drug group and the control group was significantly higher than that in the calcium group（ P 〈 0. 05）. Conclusion The bone metabolism and bone mineral density in osteoporosis patients after bone cementless type artificial total hip replacement are poor,and hip joint function recovery is poorer. Drug treatment can effectively avoid further loss of bone mass. It’s worth for further clinical promotion.