CAJ | 학술논문

背景：无论是股骨侧还是髋臼侧在髋关节置换后1年内均会出现不同程度的骨丢失，对假体的长期稳定性和骨强度造成严重影响。因而减少全髋关节置换后假体柄周围骨丢失量对延长假体使用时间、预防假体周围骨折具有重要意义。 　　目的：观察分析唑来膦酸对髋关节置换后假体柄周围骨丢失的预防效果。 　　方法：选取2011年2月至2014年9月莘县人民医院收治进行全髋关节置换的80例患者，采用随机数表法分为两组，每组40例。置换后第4天给予观察组患者唑来膦酸治疗，对照组患者不给予，两组其余用药相同。对两组置换前和置换后1年的髋部骨密度变化进行测量；观察两组置换前、用药后3d和用药后1年的血清钙、磷水平及碱性磷酸酶活性变化；对观察组患者用药期间出现的不良反应进行记录。 　　结果与结论：置换后1年两组患者股骨假体周围的平均骨密度均显著下降，与置换前比较差异有显著性意义(P<0.05)。置换后1年观察组患者的平均骨密度显著高于对照组(P<0.05)。用药后3 d两组患者的钙、磷水平均较置换前显著下降，差异均有显著性意义(P<0.05)。用药后1年钙、磷水平维持在置换前水平。置换后短期内两组患者的碱性磷酸酶活性均稍微下降，但与置换前比较差异无显著性意义(P>0.05)。用药后1年，观察组患者的碱性磷酸酶活性较低，与置换前、对照组比较差异均有显著性意义(P<0.05)。用药后1年，对照组患者的碱性磷酸酶活性与置换前差异无显著性意义(P>0.05)。用药两三天内观察组有9例患者出现不同程度的肌肉酸痛和发热，给予乙酰氨基酚后症状得到缓解。提示全髋关节置换后给予唑来膦酸注射液能够有效预防患者置换后早期假体柄周围骨丢失，但是置换后1周内可能会出现发热的症状，因此建议在置换完成1周后给予患者唑来膦酸注射液，若出现发热等症状，可给予乙酰氨基酚进行缓解。揹景：無論是股骨側還是髖臼側在髖關節置換後1年內均會齣現不同程度的骨丟失，對假體的長期穩定性和骨彊度造成嚴重影響。因而減少全髖關節置換後假體柄週圍骨丟失量對延長假體使用時間、預防假體週圍骨摺具有重要意義。 　　目的：觀察分析唑來膦痠對髖關節置換後假體柄週圍骨丟失的預防效果。 　　方法：選取2011年2月至2014年9月莘縣人民醫院收治進行全髖關節置換的80例患者，採用隨機數錶法分為兩組，每組40例。置換後第4天給予觀察組患者唑來膦痠治療，對照組患者不給予，兩組其餘用藥相同。對兩組置換前和置換後1年的髖部骨密度變化進行測量；觀察兩組置換前、用藥後3d和用藥後1年的血清鈣、燐水平及堿性燐痠酶活性變化；對觀察組患者用藥期間齣現的不良反應進行記錄。 　　結果與結論：置換後1年兩組患者股骨假體週圍的平均骨密度均顯著下降，與置換前比較差異有顯著性意義(P<0.05)。置換後1年觀察組患者的平均骨密度顯著高于對照組(P<0.05)。用藥後3 d兩組患者的鈣、燐水平均較置換前顯著下降，差異均有顯著性意義(P<0.05)。用藥後1年鈣、燐水平維持在置換前水平。置換後短期內兩組患者的堿性燐痠酶活性均稍微下降，但與置換前比較差異無顯著性意義(P>0.05)。用藥後1年，觀察組患者的堿性燐痠酶活性較低，與置換前、對照組比較差異均有顯著性意義(P<0.05)。用藥後1年，對照組患者的堿性燐痠酶活性與置換前差異無顯著性意義(P>0.05)。用藥兩三天內觀察組有9例患者齣現不同程度的肌肉痠痛和髮熱，給予乙酰氨基酚後癥狀得到緩解。提示全髖關節置換後給予唑來膦痠註射液能夠有效預防患者置換後早期假體柄週圍骨丟失，但是置換後1週內可能會齣現髮熱的癥狀，因此建議在置換完成1週後給予患者唑來膦痠註射液，若齣現髮熱等癥狀，可給予乙酰氨基酚進行緩解。
배경：무론시고골측환시관구측재관관절치환후1년내균회출현불동정도적골주실，대가체적장기은정성화골강도조성엄중영향。인이감소전관관절치환후가체병주위골주실량대연장가체사용시간、예방가체주위골절구유중요의의。 　　목적：관찰분석서래련산대관관절치환후가체병주위골주실적예방효과。 　　방법：선취2011년2월지2014년9월신현인민의원수치진행전관관절치환적80례환자，채용수궤수표법분위량조，매조40례。치환후제4천급여관찰조환자서래련산치료，대조조환자불급여，량조기여용약상동。대량조치환전화치환후1년적관부골밀도변화진행측량；관찰량조치환전、용약후3d화용약후1년적혈청개、린수평급감성린산매활성변화；대관찰조환자용약기간출현적불량반응진행기록。 　　결과여결론：치환후1년량조환자고골가체주위적평균골밀도균현저하강，여치환전비교차이유현저성의의(P<0.05)。치환후1년관찰조환자적평균골밀도현저고우대조조(P<0.05)。용약후3 d량조환자적개、린수평균교치환전현저하강，차이균유현저성의의(P<0.05)。용약후1년개、린수평유지재치환전수평。치환후단기내량조환자적감성린산매활성균초미하강，단여치환전비교차이무현저성의의(P>0.05)。용약후1년，관찰조환자적감성린산매활성교저，여치환전、대조조비교차이균유현저성의의(P<0.05)。용약후1년，대조조환자적감성린산매활성여치환전차이무현저성의의(P>0.05)。용약량삼천내관찰조유9례환자출현불동정도적기육산통화발열，급여을선안기분후증상득도완해。제시전관관절치환후급여서래련산주사액능구유효예방환자치환후조기가체병주위골주실，단시치환후1주내가능회출현발열적증상，인차건의재치환완성1주후급여환자서래련산주사액，약출현발열등증상，가급여을선안기분진행완해。
BACKGROUND:Bone loss to different degrees may appear within 1 year after hip replacement in the femoral or acetabular sides, and severely affect long-term stability of the prosthesis and bone strength. Thus, to reduce bone loss around the prosthesis stem after total hip replacement is significant to prolong the use time of the prosthesis and to prevent fractures surrounding the prosthesis. OBJECTIVE:To observe the preventive effect of zoledronic acid on bone loss surrounding the prosthesis stem after hip replacement. METHODS:A total of 80 patients after total hip replacement in the People’s Hospital of Shenxian from February 2011 to September 2014 were enrol ed in this study. They were divided into two groups (n=40). At 4 days after replacement, patients in the observation group received treatment with zoledronic acid, but those in the control group did not give zoledronic acid. The rest medication was identical between the two groups. Bone mineral density in the hip was measured before replacement and at 1 year after replacement in both groups. Serum calcium and phosphorus levels and alkaline phosphatase activities were observed before replacement, 3 days and 1 year after medication in the two groups. Adverse reaction during medication was recorded in the observation group. RESULTS AND CONCLUSION:The average bone mineral density was significantly decreased in both groups at 1 year after replacement, and significant differences were found as compared with before replacement (P<0.05). The average bone mineral density was significantly higher in the observation group than in the control group at 1 year after replacement (P<0.05). Calcium and phosphorus levels were significantly diminished at 3 days after medication as compared with that before replacement (P<0.05). Calcium and phosphorus levels maintained at the level before replacement at 1 year after medication. Alkaline phosphatase activities were slightly reduced within a short time after replacement in both groups, but no significant difference was found as compared with before replacement (P>0.05). Alkaline phosphatase activities were low in the observation group at 1 year after medication, and significant difference was detected as compared with the control group and that before replacement (P<0.05). No significant difference in alkaline phosphatase activities was detectable in the control group between 1-year post medication and pre-replacement (P>0.05). Within two or three days after medication, nine patients suffered from varying degrees of muscle aches and fever in the observation group, and above symptoms were lessened after taking acetaminophen. These results verify that after total hip replacement, zoledronic acid injection can effectively prevent bone loss around the prosthesis in early stage after replacement, but fever symptoms may occur within a week after replacement. Thus, it is recommended that zoledronic acid injection can be given at 1 week after replacement. If fever and other symptoms appear, acetaminophen can be given.