Fokter Samo K, Komadina Radko, Repse-Fokter Alenka
Department of Orthopedic Surgery and Sports Trauma, Celje General Hospital, Oblakova 5, 3000 Celje, Slovenia.
Wien Klin Wochenschr. 2006;118 Suppl 2:23-8. doi: 10.1007/s00508-006-0556-7.
Periprosthetic bone loss occurs after insertion of a total hip prosthesis and is often a result of stress shielding or altered loading of the proximal femur. Preventing the bone loss, which may threaten the prosthesis survival, with an antiresorptive drug would be highly advantageous.
Our study investigated the effect of cyclic etidronate therapy on periprosthetic, contralateral hip, and spine bone mineral density (BMD) in a one-year, prospective, randomized, double-blind study in 31 patients after cemented hip arthroplasty. Etidronate was taken orally in a regimen repeated every 14 weeks, and periprosthetic BMD was measured with dual energy X-ray absorptiometry (DXA) in the total periprosthetic area and in the seven Gruen zones at 1 week (baseline), 6 weeks, 3 months, 6 months, and 12 months postoperatively.
In the etidronate group there were significant temporal BMD decreases measured in Gruen zones 2, 3, 6, and 7 and in the entire proximal femur; the greatest decrease was 12.9% and was measured in zone 7 at six months. Also in the etidronate group, there was a significant 2.8% temporal BMD increase in the spine at 12 months. In the placebo group there were significant temporal BMD decreases measured in Gruen zones 1, 2, 3, 5, 6, and 7 and in the entire proximal femur; the greatest decrease was 25.5% and was measured in zone 7 at 12 months. There were no significant differences between the mean BMD measurements of the etidronate and placebo groups.
These findings suggest that cyclic etidronate therapy has no significant effect in suppressing periprosthetic bone loss after cemented hip arthroplasty.
全髋关节假体植入后会发生假体周围骨丢失,这通常是应力遮挡或股骨近端负荷改变的结果。使用抗吸收药物预防可能威胁假体存活的骨丢失将非常有益。
我们的研究在31例接受骨水泥型髋关节置换术的患者中进行了一项为期一年的前瞻性、随机、双盲研究,调查了周期性依替膦酸治疗对假体周围、对侧髋关节和脊柱骨密度(BMD)的影响。依替膦酸采用每14周重复一次的方案口服,术后1周(基线)、6周、3个月、6个月和12个月时,使用双能X线吸收法(DXA)在整个假体周围区域和七个Gruen区测量假体周围骨密度。
在依替膦酸组中,Gruen区2、3、6和7以及整个股骨近端的骨密度随时间显著下降;最大降幅为12.9%,在6个月时于7区测得。同样在依替膦酸组中,12个月时脊柱骨密度随时间显著增加2.8%。在安慰剂组中,Gruen区1、2、3、5、6和7以及整个股骨近端的骨密度随时间显著下降;最大降幅为25.5%,在12个月时于7区测得。依替膦酸组和安慰剂组的平均骨密度测量值之间无显著差异。
这些发现表明,周期性依替膦酸治疗在抑制骨水泥型髋关节置换术后假体周围骨丢失方面没有显著效果。