CAJ | 학술논문

目的：观察老年患者骨科围术期骨代谢变化特点及术后应用鲑鱼降钙素对骨代谢的影响。方法年龄＞60岁老年患者90例纳入本研究，男性21例，女性69例。其中行髋关节手术37例，膝关节手术38例，腰椎手术15例。将研究对象随机分为2组，治疗组45例，术后应用鲑鱼降钙素＋碳酸钙片＋活性维生素D抗骨质疏松治疗；对照组45例，术后应用碳酸钙片＋活性维生素D治疗。分别于术前、术后1周、术后3个月测定静脉血骨钙素（OC）及Ⅰ型胶原交联C端肽（β-CTX）水平；于术前、术后3个月采用DEXA双能X线骨密度仪测定患者腰椎及髋部骨密度。结果共78例患者完成随访，对照组（ n＝37）术后1周β-CTX均值较术前明显升高（ P＜0.001），术后3个月较术前变化无统计学意义（ P＞0.05）；治疗组（ n＝41）术后1周β-CTX均值较术前明显升高（ P＜0.001），术后3个月较术前明显降低（ P＜0.05）；对照组术后1周OC均值较术前明显降低（ P＜0.05），术后3个月较术前无明显变化（ P＞0.05）；治疗组术后1周OC均值较术前明显降低（P＜0.001），术后3个月较术前无明显变化（P＞0.05）；治疗组与对照组腰椎、髋部BMD术前与术后3个月差异均无统计学意义（均P＞0.05）。结论老年患者接受骨科手术前后骨代谢发生改变，手术后1周骨吸收过程活跃，骨形成过程受抑制；术后应用鲑鱼降钙素3个月抗骨质疏松治疗能有效抑制骨吸收，但对促进骨形成无明显影响。
목적：관찰노년환자골과위술기골대사변화특점급술후응용해어강개소대골대사적영향。방법년령＞60세노년환자90례납입본연구，남성21례，녀성69례。기중행관관절수술37례，슬관절수술38례，요추수술15례。장연구대상수궤분위2조，치료조45례，술후응용해어강개소＋탄산개편＋활성유생소D항골질소송치료；대조조45례，술후응용탄산개편＋활성유생소D치료。분별우술전、술후1주、술후3개월측정정맥혈골개소（OC）급Ⅰ형효원교련C단태（β-CTX）수평；우술전、술후3개월채용DEXA쌍능X선골밀도의측정환자요추급관부골밀도。결과공78례환자완성수방，대조조（ n＝37）술후1주β-CTX균치교술전명현승고（ P＜0.001），술후3개월교술전변화무통계학의의（ P＞0.05）；치료조（ n＝41）술후1주β-CTX균치교술전명현승고（ P＜0.001），술후3개월교술전명현강저（ P＜0.05）；대조조술후1주OC균치교술전명현강저（ P＜0.05），술후3개월교술전무명현변화（ P＞0.05）；치료조술후1주OC균치교술전명현강저（P＜0.001），술후3개월교술전무명현변화（P＞0.05）；치료조여대조조요추、관부BMD술전여술후3개월차이균무통계학의의（균P＞0.05）。결론노년환자접수골과수술전후골대사발생개변，수술후1주골흡수과정활약，골형성과정수억제；술후응용해어강개소3개월항골질소송치료능유효억제골흡수，단대촉진골형성무명현영향。
Objective To observe the changes of bone metabolism of elderly people , and the effect of anti-oste-oporosis treatment to bone metabolism during orthopaedic perioperative period. Methods 90 patients (21 males and 69 females, 60 ~89 years old) were selected into randomized clinically controlled trial .The treatment group ( n=45 ) re-ceived salmon calcitonin , calcium carbonate and active vitamin D to anti-osteoporosis treatment; the control ( n =45 ) group received calcium carbonate and active vitamin D only .Osteocalcin ( OC) , C-terminal Telopeptides of Type I colla-gen (β-CTX) in serum were measured by ECLIA in all patients preoperatively , 1 week after operation and 3 months after operation.Bone mineral density (BMD) were measured by dual-energy X-ray densitometer preoperatively and 3 months after operation .β-CTX, OC and BMD were compared before and after operation .Results 78 patients completed the study.The β-CTX level increased 1 week postoperatively (P<0.001) and did not change significantly 3 months postop-eratively ( P>0.05 ) in the control group;theβ-CTX level increased 1 week postoperatively ( P<0.001 ) but decreased significantly 3 months postoperatively ( P<0.05 ) in the treatment group .The OC level decreased 1 week postoperatively ( P<0.05 ) and did not change significantly 3 months postoperatively ( P>0.05 ) in the control group;the OC level de-creased 1 week postoperatively ( P<0.001 ) and did not change significantly 3 months postoperatively ( P>0.05 ) in the treatment group .There was no significant difference between the mean BMD in lumber and hip before and 3 months after operation in each group ( P>0.05 ) .Conclusion The elderly patients had bone metabolism changes before and after or-thopedic operation .In a relatively short time after operation (1 week) , the postoperative β-CTX was higher than preoper-ative, suggesting that bone resorption increased after operation;the postoperative OC was lower than preoperative , sugges-ting that the new bone formation was decreased .Treatment with salmon calcitonin for three months postoperatively could inhibit bone resorption , but it had no significant effect in promoting bone formation .After a short period (3 months after operation), the BMD did not change significantly .