阿法骨化醇联合生物假体全髋关节置换治疗老年骨质疏松性髋部骨折的临床研究

Effects of Alfacalcidol Combined with Total Hip Arthroplasty on Geriatric Osteoporotic Hip Fracture and Quality of Life

目的探究阿法骨化醇联合生物假体全髋关节置换治疗老年骨质疏松性髋部骨折的中远期疗效及生活质量评价。方法选择2014年7月~2015年7月于上海交通大学附属第六人民医院接受治疗的200例老年骨质疏松性髋部骨折患者作为研究对象,根据所采取的治疗方案不同分为研究组(114例)与对照组(86例),两组患者均进行生物假体全髋关节置换治疗,对照组于术后2周口服维D钙,研究组在对照组治疗基础上加用阿法骨化醇。比较两组患者的髋关节功能Harris评分、生活质量评分、骨代谢与骨密度情况、术后3年假体松动及再手术情况。结果治疗后研究组Harris评分与生活质量评分均明显高于对照组(P<0.001);治疗后研究组血清骨钙素(BGP)、Ⅰ型胶原N末端肽(NTX)、Ⅰ型胶原C端肽(CTX)水平均明显低于对照组(P<0.001),骨密度水平明显高于对照组(P<0.05);随访3年后,研究组假体松动率与再手术率均明显低于对照组(P<0.05)。结论阿法骨化醇联合生物假体全髋关节置换治疗老年骨质疏松性髋部骨折的中远期疗效显著,能明显改善患者的髋关节功能,提高骨密度,调节患者的骨代谢紊乱。

Objective To explore the effects of alfacalcitol combined with bioprosthesis total hip arthroplasty on osteoporotic hip fracture and quality of life in older patients.Methods 200 patients with geriatric osteoporotic hip fractures from July 2014 to July 2015 were selected in the Sixth People's Hospital Affiliated to Shanghai Jiaotong University.The patients were divided into the research group(114 cases)and the control group(86 cases)according to the treatment plan.All patients underwent bioprosthesis total hip arthroplasty.From two weeks after surgery,the control group received oral D-calcium,while the research group received D-calcium plus alfacalcidol for 6 months.Harris score,quality of life,bone metabolism and bone mineral density,prosthesis loosening and reoperation were documented.Results After treatment,Harris score and quality of life score in the research group were significantly higher than those in the control group(P<0.001).In the research group,the levels of serum bone glaprotein(BGP),N-telopeptide of typeⅠcollagen(NTX),and C-terminal telopeptide of typeⅠcollagen(CTX)were significantly lower than those in the control group(P<0.001),and the bone mineral density was significantly higher than that in the control group(P<0.05).After 3 years of follow-up,the prosthesis loosening rate and reoperation rate in the research group were significantly lower than those in the control group(P<0.05).Conclusion Alfacalcidol combined with bioprosthesis total hip arthroplasty could improve hip function,increase bone mineral density,and regulate bone metabolic disorders in older patients with osteoporotic hip fractures.