CAJ | 학술논문

目的：观察唑来膦酸注射液（密固达）防治全髋关节置换术后假体柄周围骨丢失的近期临床疗效。方法2012年5月－2012年6月接受单侧全髋关节置换术患者，共20例，随机分为唑来膦酸组（观察组）和对照组。观察组术后1周接受唑来膦酸注射液静脉滴注，5 mg／次，共1次；对照组不接受唑来膦酸注射液治疗。术前、术后1年分别运用双能X骨密度仪测量股骨柄周围骨密度，分析骨量变化情况。结果共入选20例患者，两组各10例，随访1年；术后1年两组股骨假体周围平均骨密度均有所下降，I区和VII区下降显著，观察组IV区骨密度增高趋势。观察组股骨侧骨密度由术前平均1．523±0．325降至1．463±0．376，对照组由平均1．579±0．286降至1．295±0．357。术后3天两组钙、磷水平较术前稍下降，1年后均维持在术前水平。两组术后短期内ALP稍有所下降，与术前水平比较无显著差异；术后1年，对照组ALP恢复术前水平，观察组ALP处于较低水平，与术前及对照组比较具有显著差异。观察组用药后2－3天内有8例患者出现不同程度发热或肌肉酸痛，经服用乙酰氨基酚（泰诺林）缓解。结论唑来膦酸注射液可有效预防全髋关节置换术后早期假体柄周围骨量丢失，具有良好的依从性，但存在流感样副作用，术后1周内难以与手术相关发热相鉴别，故建议手术1周后，待全身情况稳定后使用，出现发热等症状时，给予乙酰氨基酚等消炎止痛类药物可缓解，未见其他不良反应。
목적：관찰서래련산주사액（밀고체）방치전관관절치환술후가체병주위골주실적근기림상료효。방법2012년5월－2012년6월접수단측전관관절치환술환자，공20례，수궤분위서래련산조（관찰조）화대조조。관찰조술후1주접수서래련산주사액정맥적주，5 mg／차，공1차；대조조불접수서래련산주사액치료。술전、술후1년분별운용쌍능X골밀도의측량고골병주위골밀도，분석골량변화정황。결과공입선20례환자，량조각10례，수방1년；술후1년량조고골가체주위평균골밀도균유소하강，I구화VII구하강현저，관찰조IV구골밀도증고추세。관찰조고골측골밀도유술전평균1．523±0．325강지1．463±0．376，대조조유평균1．579±0．286강지1．295±0．357。술후3천량조개、린수평교술전초하강，1년후균유지재술전수평。량조술후단기내ALP초유소하강，여술전수평비교무현저차이；술후1년，대조조ALP회복술전수평，관찰조ALP처우교저수평，여술전급대조조비교구유현저차이。관찰조용약후2－3천내유8례환자출현불동정도발열혹기육산통，경복용을선안기분（태낙림）완해。결론서래련산주사액가유효예방전관관절치환술후조기가체병주위골량주실，구유량호적의종성，단존재류감양부작용，술후1주내난이여수술상관발열상감별，고건의수술1주후，대전신정황은정후사용，출현발열등증상시，급여을선안기분등소염지통류약물가완해，미견기타불량반응。
Objective To observe the short-term clinical efficacy of zoledronic acid injection ( Aclasta ) on preventing periprosthetic bone loss around the femoral stem after the total hip arthroplasty.Methods Twenty patients, who underwentthe unilateral total hip arthroplasty from May 2012 to June 2012, were included and randomly divided into zoledronic acid group ( observation group) and control group.One week after the operation, patients in the observation group received one intravenous injection of 5 mg zoledronic acid (Aclasta), while patients in the control group did not receive the injection.The bone mineral density ( BMD) around the femoral stem was detected using dual-energy X-ray absorptiometry preoperatively and 1-year after the operation.The results were used to analyze the bone mass change.Results A total of 20 patients were included, and each group contained 10 patients.The followed-up lasted for 1 year.The mean BMD around the femoral stem in both groups decreased 1-year after the operation, especially at Zone I and VII.But in the observation group, BMD at Zone IV showed a trend of increase.The mean BMD in the observation group decreased from preoperative 1.523 ±0.325 to postoperative 1.463 ±0.376, while the decrease was from preoperative 1.579 ±0.286 to postoperative1.295 ±0.357 in the control group.Compared to the preoperative level, the serum levels of calcium and phosphorus decreased slightly 3-day after the operation.But it maintained at the preoperative level 1-year after the operation.The serum ALP level in both groups declined slightly at early stage after the operation.One year later, the serum ALP in the control group returned to preoperative level, while the serum level in the observation group was lower than the preoperative level, and the difference between two groups was significant.Within 2-3 days after the injection, 8 patients in the observation group had varying degree of fever or muscle ache, which relieved after taking acetaminophen (Tylenol).Conclusion Zoledronic acid injection ( Aclasta ) is effective in preventing early postoperative periprosthetic bone loss after total hip arthroplasty.It is with good compliance, but there is flu-like side effect.And it is difficult to differentiate the side effect from the fever associated with surgery in 1 week after the operation.So, it is recommended that zoledronic acid injection ( Aclasta) should be used 1 week after the operation, when the body is in stable condition.If fever or other symptoms occur, acetaminophen or other anti-inflammatory drugs can be used.And no any other adverse reactions are observed.