中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (33): 5265-5272.doi: 10.12307/2021.312

• 人工假体 artificial prosthesis • 上一篇    下一篇

唑来膦酸干预老年骨质疏松性股骨转子间骨折髋关节置换后患者骨密度、骨代谢标志物的2年随访

邱  伟1，连星烨2   

  1. 1广元市中心医院骨二科，四川省广元市   628000；2云南省第一人民医院骨科，云南省昆明市   650200
  • 收稿日期:2020-11-03 修回日期:2020-11-06 接受日期:2020-12-31 出版日期:2021-11-28 发布日期:2021-08-02
  • 通讯作者: 连星烨，硕士，主治医师，云南省第一人民医院骨科，云南省昆明市 650200
  • 作者简介:邱伟，男，1984年生，四川省广元市人，2011年昆明医学院毕业，硕士，主治医师，主要从事脊柱外科和创伤外科的临床工作。

Effect of zoledronic acid on bone mineral density and bone metabolism markers in elderly patients with osteoporotic intertrochanteric fracture after hip arthroplasty: 2-year follow-up

Qiu Wei1, Lian Xingye2   

  1. 1Second Department of Orthopedics, Guangyuan Central Hospital, Guangyuan 628000, Sichuan Province, China; 2Department of Orthopedics, Yunnan First People’s Hospital, Kunming 650200, Yunnan Province, China
  • Received:2020-11-03 Revised:2020-11-06 Accepted:2020-12-31 Online:2021-11-28 Published:2021-08-02
  • Contact: Lian Xingye, Master, Attending physician, Department of Orthopedics, Yunnan First People’s Hospital, Kunming 650200, Yunnan Province, China
  • About author:Qiu Wei, Master, Attending physician, Second Department of Orthopedics, Guangyuan Central Hospital, Guangyuan 628000, Sichuan Province, China

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摘要：

文题释义：
骨质疏松症：是由于多种原因导致的骨密度和骨质量下降，骨微结构破坏，造成骨脆性增加，从而容易发生骨折的全身性骨病。骨质疏松症分为原发性和继发性二大类，原发性骨质疏松症又分为绝经后骨质疏松症(Ⅰ型)、老年性骨质疏松症(Ⅱ型)和特发性骨质疏松(包括青少年型)3种。绝经后骨质疏松症一般发生在妇女绝经后5-10年内；老年性骨质疏松症一般指老人70岁后发生的骨质疏松；而特发性骨质疏松主要发生在青少年，病因尚不明。
唑来膦酸：是一种二膦酸盐药物，能特异性地作用于骨的双膦酸化合物，抑制因破骨活性增加而导致的骨吸收，但对骨形成、骨矿化及力学特性没有不良影响。唑来膦酸的主要药理作用是抑制骨吸收，其作用机制尚不完全清楚，可能与多方面作用有关。唑来膦酸在体外可抑制破骨细胞活动，诱导破骨细胞凋亡，还可以通过与骨的结合阻断破骨细胞对矿化骨和软骨的吸收。唑来膦酸还可抑制因肿瘤产生的多种刺激因子诱发的破骨细胞活性增加和骨钙释放。
背景：近年来人工关节置换在股骨转子间骨折的外科治疗上取得很好的疗效。由于存在骨质疏松，术后内植物松动下沉、假体周围骨折等情况也成为术后的严重并发症之一。老年骨质疏松性骨折除手术治疗外，还需联合抗骨质疏松药物治疗，以降低再发骨折或内植物松动的风险。
目的：探讨老年股骨转子间骨折患者行人工髋关节置换后抗骨质疏松治疗的临床意义。
方法：纳入46例老年骨质疏松性股骨转子间骨折行人工股骨头置换的患者，均为女性，根据治疗方案分为2组。治疗组22例术后使用唑来膦酸(每年1次，共输注3次)，并规律口服骨化三醇及钙尔奇D抗骨质疏松治疗；对照组24例术后未使用唑来膦酸，仅以骨化三醇及钙尔奇D规律口服抗骨质疏松治疗。治疗前和治疗后6，12，24个月行骨密度检测和骨代谢标志物测定，骨形成标志物选取血清骨钙素，骨吸收标志物选取抗酒石酸酸性磷酸酶5b。骨密度检测使用双能X射线骨密度仪，骨代谢指标采用ELISA法检测。
结果与结论：①治疗后两组患者骨密度均有不同程度提升，治疗1年后治疗组的骨密度优于对照组(P < 0.05)；②骨形成标志物(骨钙素)水平伤后一过性升高，治疗组6个月后开始逐渐升高，差异有显著性意义(P < 0.05)；对照组6个月后维持在一定水平；在6个月后两组之间的差异即有显著性意义(P < 0.05)；③骨吸收标志物(抗酒石酸酸性磷酸酶5b)水平伤后出现升高，治疗组治疗后逐渐下降，差异有显著性意义(P < 0.05)；对照组治疗后下降不明显，差异无显著性意义(P > 0.05)；两组之间的差异在治疗后12，24个月出现显著性意义(P < 0.05)；④提示唑来膦酸可进一步辅助老年股骨转子间骨折患者行人工髋关节置换后抗骨质疏松治疗，在骨密度的提升、促骨形成、抑制骨吸收方面均发挥重要作用。
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨质疏松症, 老年股骨转子间骨折, 唑来膦酸, 骨密度, 骨代谢标志物

Abstract: BACKGROUND: In recent years, artificial joint arthroplasty has achieved good results in the surgical treatment of intertrochanteric fractures. Due to the presence of osteoporosis, postoperative loosening and subsidence of implant, periprosthetic fracture and other conditions have become one of serious postoperative complications. In addition to surgical treatment, senile osteoporotic fracture should be combined with anti-osteoporosis drugs to reduce the risk of recurrent fracture or implant loosening.  
OBJECTIVE: To study the clinical significance of anti-osteoporosis treatment in elderly patients with intertrochanteric fracture after artificial hip arthroplasty.
METHODS:  Forty-six elderly female patients with osteoporotic intertrochanteric fractures who underwent artificial femoral head replacement were included and were divided into two groups according to the treatment plan. Twenty-two patients in the treatment group were treated with zoledronic acid (once a year, a total of three infusions), and regularly orally taken calcitriol and caltrate D for anti-osteoporosis treatment. Twenty-four patients in the control group were regularly orally taken calcitriol and caltrate D for anti-osteoporosis treatment, with the absence of zoledronic acid. Bone mineral density and bone metabolism markers were measured before treatment and 6, 12 and 24 months after treatment. Serum osteocalcin was selected as bone formation marker, and tartrate resistant acid-base phosphatase-5b was selected as bone absorption marker. Dual-energy X-ray absorptiometry was used to detect bone mineral density, and ELISA was used to detect bone metabolism.  
RESULTS AND CONCLUSION: (1) After treatment, the bone mineral density of the two groups increased in different degrees, and bone mineral density was better in the treatment group than that in the control group 1 year after treatment (P < 0.05). (2) Bone formation markers (osteocalcin) increased temporarily after injury, and gradually increased in the treatment group after 6 months; the difference was statistically significant (P < 0.05). The control group maintained at a certain level after 6 months. The difference between the two groups was statistically significant after 6 months (P < 0.05). (3) Bone resorption markers (tartrate resistant acid-base phosphatase-5b) increased after injury, and gradually decreased in the treatment group; the difference was statistically significant (P < 0.05). The decrease was not significant in the control group after treatment, and the difference was not significant (P > 0.05). The difference between the two groups was statistically significant 12 and 24 months after treatment (P < 0.05). (4) It is concluded that zoledronic acid can further assist in the anti-osteoporosis treatment of elderly patients with intertrochanteric fracture after hip arthroplasty, which plays an important role in improving bone mineral density, promoting bone formation and inhibiting bone resorption.

Key words: osteoporosis, intertrochanteric fractures in the elderly, zoledronic acid, bone mineral density, bone metabolism markers

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