摘要
目的探讨膝关节骨关节炎(OA)合并骨质疏松(OP)患者应用抗骨质疏松药物联合人工全膝关节置换术(TKA)治疗的临床效果。方法前瞻性选取2022年8月至2023年8月首都医科大学附属北京安贞医院南充医院南充市中心医院收治的100例OA合并OP患者作为研究对象,按随机数表法分为对照组(TKA治疗方案)和抗骨质疏松组(TKA联合抗骨质疏松药物治疗方案)各50例,比较两组患者围术期指标,术前、术后7 d、术后1个月及术后3个月膝关节疼痛程度[视觉模拟评分法(VAS)]评分,术前及术后12个月腰椎/髋部/假体周围的骨密度,术前、术后3个月、6个月、12个月膝关节功能[美国特种外科医院(HSS)]评分,同时比较两组患者的并发症发生情况及安全性。结果抗骨质疏松组患者术中失血量、术后24 h引流量、总失血量分别为(672.41±17.71)m L、(231.67±35.69)mL、(863.34±25.33)m L,明显少于对照组的(695.53±28.64)mL、(247.65±38.41)m L、(912.65±26.87)m L,差异均有统计学意义(P<0.05)。两组患者术前、术后7 d的膝关节VAS评分比较差异均无统计学意义(P>0.05);术后1个月、3个月,抗骨质疏松组患者的VAS评分分别为(2.52±0.56)分、(1.53±0.31)分,明显低于对照组的(3.34±0.42)分、(2.28±0.65)分,差异均有统计学意义(P<0.05)。术后12个月,抗骨质疏松组患者的腰椎骨密度值、髋部骨密度值、假体周围骨密度值分别为(0.86±0.13)g/cm^(3)、(0.81±0.19)g/cm^(3)、(0.73±0.17)g/cm^(3),明显高于对照组的(0.71±0.12)g/cm^(3)、(0.63±0.20)g/cm^(3)、(0.59±0.19)g/cm^(3),差异均有统计学意义(P<0.05)。术后3个月、6个月、12个月,抗骨质疏松组患者的HSS膝关节评分分别为(63.61±13.05)分、(76.72±12.51)分、(89.61±11.21)分,明显高于对照组的(52.34±12.76)分、(68.97±9.63)分、(80.43±13.68)分,差异均有统计学意义(P<0.05)。抗骨质疏松组患者的并发症发生率为6.00%,明显低于对照组的20.00%,差异有统计学意义(P<0.05);两组患者术后6个月和12个月的假体松动、假体周围感染发生率比较差异均无统计学意义(P>0.05)。结论抗骨质疏松药物联合TKI治疗OA合并OP患者的手术效果更为显著,其能减少手术总失血量,改善患者术后膝关节功能,提高骨密度,减少术后并发症的发生,具有一定的安全性。
Objective To evaluate the clinical efficacy of anti-osteoporosis therapy combined with total knee arthroplasty(TKA)in patients with knee osteoarthritis(OA)complicated with osteoporosis(OP).Methods One hun-dred OA patients with OP in Beijing Anzhen Nanchong Hospital,CapitaMedical University&Nanchong Central Hospital from August 2022 to August 2023 were prospectively selected and were divided into a control group(TKA)and an anti-osteoporosis group(TKA combined with anti-osteoporosis drugs)by random number table method,with 50 cases in each group.The perioperative indexes,knee pain degree(Visual Analogue Scale[VAS])before surgery and at 7 days,1 month and 3 months after surgery,lumbar/hip/periprosthetic bone mineral density before surgery and at 12 months after surgery,knee function(Hospital for Special Surgery[HSS])before surgery and at 3 months,6 months and 12 months after surgery were compared between the two groups.The occurrence of complications and safety were also compared be-tween the two groups.Results In the anti-osteoporosis group,the intraoperative blood loss,drainage volume at 24 hours after surgery,and total blood loss were(672.41±17.71)mL,(231.67±35.69)mL,and(863.34±25.33)mL,significantly less than(695.53±28.64)mL,(247.65±38.41)mL,and(912.65±26.87)mL in the control group(P<0.05).There were no statistically significant differences in the knee VAS scores before surgery and at 7 days after surgery between the two groups(P>0.05).VAS scores at 1 month and 3 months after surgery were(2.52±0.56)points and(1.53±0.31)points in the anti-osteoporosis group,which were significantly lower than(3.34±0.42)points and(2.28±0.65)points in the control group(P<0.05).At 12 months after surgery,the lumbar bone mineral density,hip bone mineral density,and periprosthet-ic bone mineral density in the anti-osteoporosis group were(0.86±0.13)g/cm^(3),(0.81±0.19)g/cm^(3),and(0.73±0.17)g/cm^(3),significantly higher than(0.71±0.12)g/cm^(3),(0.63±0.20)g/cm^(3),and(0.59±0.19)g/cm^(3) in the control group(P<0.05).At 3 months,6 months,and 12 months after surgery,the HSS knee joint scores were(63.61±13.05)points,(76.72±12.51)points,and(89.61±11.21)points in the anti-osteoporosis group,significantly higher than(52.34±12.76)points,(68.97±9.63)points,and(80.43±13.68)points in the control group(P<0.05).The incidence of complications was 6.00%in the anti-osteoporosis group,significantly lower than 20.00%in the control group(P<0.05).There were no statistically significant differences in the incidence rates of prosthesis loosening and periprosthetic infection between the two groups at 6 and 12 months after surgery(P>0.05).Conclusion Anti-osteoporosis drug combined with TKI has a more significant surgical effect in the treatment of patients with OA and OP.It can reduce the total surgical blood loss,improve the postoperative knee function,enhance the bone mineral density,and reduce the occurrence of postoperative complications,demonstrating certain safety.
作者
袁映红
张俊
赵鑫
宋慧敏
肖涛
YUAN Ying-hong;ZHANG Jun;ZHAO Xin;SONG Hui-min;XIAO Tao(Department of Orthopedics,Capital Medical University&Nanchong Central Hospital,Nanchong 637000,Sichuan,CHINA;Operating Room,Beijing Anzhen Nanchong Hospital,Capital Medical University&Nanchong Central Hospital,Nanchong 637000,Sichuan,CHINA)
出处
《海南医学》
2025年第12期1705-1709,共5页
Hainan Medical Journal
基金
四川省基层卫生事业发展研究中心课题(编号:SWFZ23-Y-56)。
