补肾活血法防治绝经女性全膝关节置换术后假体周围骨丢失的研究

Study on prevention and treatment with Bushen Huoxue decoction for bone loss around the prosthesis after total knee arthroplasty in postmenopausal women

目的观察绝经女性全膝关节置换术后假体周围骨丢失的规律,探讨补肾活血法防治肾虚血瘀型绝经后膝关节置换术患者假体周围骨丢失的效果。方法将60例肾虚血瘀型绝经女性膝骨关节炎行全膝关节置换术的患者随机分为治疗组和对照组,每组30例。对照组术后给予骨化三醇胶丸+钙尔奇D片口服,治疗组给予补肾活血中药龙鳖胶囊+骨化三醇胶丸+钙尔奇D片口服,2组均连续治疗3个月。分别于术后1周、3个月、6个月、9个月,采用双能X射线骨密度仪检测2组患者膝关节假体周围的骨密度。结果2组术后3个月、6个月、9个月时股骨假体上方远端兴趣区(ROI1区)、胫骨假体下方近端兴趣区(ROI2区)的骨密度均明显低于术后1周(P均<0.05),且骨密度均呈进行性降低,其中术后前3个月下降较为明显,术后6~9个月下降趋缓;治疗组术后6个月、9个月时ROI1区骨密度和术后3个月、6个月、9个月时ROI2区骨密度均明显高于对照组(P均<0.05)。结论绝经后女性全膝关节置换术后假体周围骨量在术后前6个月呈快速下降趋势,术后6~9个月下降趋于平缓。补肾活血中药配合抗骨质疏松药物可以有效防治肾虚血瘀型绝经后膝关节置换术患者假体周围骨丢失。

Objective It is to observe the law of bone loss around the prosthesis after total knee arthroplasty in menopausal women,and to explore the effect of Bushen Huoxue method on prevention and treatment of bone loss around the prosthesis in patients with post-menopausal knee joint replacement.Methods Sixty menopausal patients with knee osteoarthritis of type of kidney deficiency and blood stasis who underwent total knee arthroplasty were randomly divided into treatment group and control group,30 cases in each group.The patients in the control group were given calcitriol capsules+Calcium D tablets orally,and the treatment group was additionally treated with Longbie capsule for oral administration on the basis of therapy in the control group.Both groups were treated for 3 months.Bone mineral density around the knee joint prosthesis of the 2 groups was measured by dual-energy X-ray absorptiometry at 1 week,3 months,6 months,and 9 months after surgery.Results The bone mineral density in the distal interest area of upper part of the femoral component(ROI area 1)and the proximal interest area(ROI 2 area)of the tibial component in the 2 groups at 3 months,6 months and 9 months after operation were significantly lower than those at 1 week after operation(P<0.05),and bone mineral density showed progressive decline,which decreased significantly in the first 3 months after surgery,and slowed down after 6 to 9 months after operation.The bone mineral density in ROI area 1 at 6 months,9 months after surgery and the bone mineral density in ROI area 2 at 3 months,6 months and 9 months after operation were significantly higher than those in the control group(P<0.05).Conclusion The total bone mass of the prosthesis in postmenopausal women after total knee arthroplasty showed a rapid decline in the first 6 months after surgery,and the decline was smoother in 6 to 9 months after operation.Chinese herbal medicine for invigorating kidney and promoting blood circulation combined with anti-osteoporosis drugs can effectively prevent bone loss around the prosthesis in patients with syndrome of kidney deficiency and blood stasis undergoing post-menopausal knee joint replacement.