[1]吴连国,刘康,黄俊俊,等.强骨饮对股骨颈骨折患者人工股骨头置换术后假体周围骨密度的影响[J].中医正骨,2014,26(04):15-18.
 Wu Lianguo*,Liu Kang,Huang Junjun,et al.Effect of QIANGGU DRINK on peri-prosthetic bone density after artificial femoral head replacement in patients with femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2014,26(04):15-18.
点击复制

强骨饮对股骨颈骨折患者人工股骨头置换术后假体周围骨 密度的影响()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第26卷
期数:
2014年04期
页码:
15-18
栏目:
临床研究
出版日期:
2014-04-30

文章信息/Info

Title:
Effect of QIANGGU DRINK on peri-prosthetic bone density after artificial femoral head replacement in patients with femoral neck fractures
作者:
吴连国1刘康1黄俊俊1毛应德龙1陈华2史晓林1
1.浙江中医药大学附属第二医院,浙江 杭州 310005; 2.浙江中医药大学附属第三医院,浙江 杭州 310005
Author(s):
Wu Lianguo*Liu KangHuang JunjunMao YingdelongChen HuaShi Xiaolin.*
The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310005,Zhejiang,China
关键词:
关节成形术置换髋 骨密度 股骨颈骨折 手术后并发症 强骨饮
Keywords:
Arthroplastyreplacementhip Bone density Femoral neck fractures Postoperative complications QIANGGU DRINK
摘要:
目的:探讨强骨饮对股骨颈骨折患者人工股骨头置换术后假体周围骨密度的影响。方法:股骨颈骨折患者78例,按就诊顺序随机分为观察组和对照组,每组39例; 2组患者均进行人工股骨头置换术,术后分别采用口服钙尔奇D片和强骨饮及单纯口服钙尔奇D片进行干预。观察2组患者术后髋关节功能恢复情况; 将人工假体柄周围分为7个区(R1~R7),测量2组患者各区术后1周、术后3个月、术后6个月时假体周围的骨密度,并进行比较。结果:78例患者均顺利完成手术,74例获得随访,观察组失访3例,对照组失访1例; 随访时间9~24个月,中位数18.5个月; 患肢疼痛缓解、髋关节功能恢复。参照Harris髋关节评分标准对患肢髋关节进行评分,治疗组(87.5±7.6)分,对照组(86.7±8.1)分,2组间差异无统计学意义(t=10.437,P=0.896)。均无假体松动等并发症发生。R1区,各时间点间骨密度值比较,差异有统计学意义(F=76.367,P=0.000),存在时间效应; 2组间骨密度值比较,差异有统计学意义(F=6.375,P=0.001),存在分组效应; 术后1周,2组间骨密度值比较,差异无统计学意义[(0.772±0.214)g·cm-2,(0.761±0.178)g·cm-2; t=0.578,P=0.683); 术后3个月、术后6个月,观察组骨密度值均高于对照组[(0.758±0.268)g·cm-2,(0.602±0.244)g·cm-2; t=2.232,P=0.024;(0.732±0.227)g·cm-2,(0.518±0.188)g·cm-2; t=2.847,P=0.004)]; 时间因素和分组因素存在交互效应(F=36.726,P=0.000)。R2~R6区骨密度值 [R2:(1.532±0.342)g·cm-2,(1.478±0.451)g·cm-2,(1.432±0.403)g·cm-2;(1.613±0.268)g·cm-2,(1.582±0.265)g·cm-2,(1.533±0.275)g·cm-2。R3:(1.746±0.276)g·cm-2,(1.641±0.324)g·cm-2,(1.615±0.327)g·cm-2;(1.692±0.312)g·cm-2,(1.634±0.403)g·cm-2,(1.589±0.157)g·cm-2。R4:(1.831±0.302)g·cm-2,(1.768±0.256)g·cm-2,(1.711±0.236)g·cm-2;(1.798±0.275)g·cm-2,(1.735±0.358)g·cm-2,(1.636±0.326)g·cm-2。R5:(1.736±0.257)g·cm-2,(1.677±0.389)g·cm-2,(1.632±0.324)g·cm-2;(1.812±0.362)g·cm-2,(1.752±0.265)g·cm-2,(1.698±0.424)g·cm-2。R6:(1.563±0.352)g·cm-2,(1.612±0.327)g·cm-2,(1.578±0.367)g·cm-2;(1.642±0.279)g·cm-2,(1.598±0.278)g·cm-2(1.504±0.276)g·cm-2]各时间点间比较,差异均无统计学意义(F=2.468,P=0.162; F=1.569,P=0.453; F=1.862,P=0.358; F=3.556,P=0.112; F=4.065,P=0.104); 2组间比较,差异均无统计学意义(F=1.679,P=0.153; F=0.879,P=0.553; F=2.568,P=0.122; F=3.512,P=0.098; F=4.679,P=0.082); 时间因素和分组因素存在交互效应(F=26.765,P=0.000; F=23.343,P=0.000; F=28.276,P=0.000; F=21.825,P=0.000; F=26.468,P=0.000)。R7区,各时间点间骨密度值比较,差异有统计学意义(F=52.828,P=0.000),存在时间效应; 2组间骨密度值比较,差异有统计学意义(F=12.476,P=0.000),存在分组效应; 术后1周,2组间骨密度值比较,差异无统计学意义[(1.292±0.262)g·cm-2,(1.203±0.322)g·cm-2; t=1.578,P=0.167]; 术后3个月、术后6个月,观察组骨密度值均高于对照组[(1.178±0.345)g·cm-2,(0.869±0.159)g·cm-2; t=3.025,P=0.002;(1.123±0.312)g·cm-2,(0.752±0.328)g·cm-2; t=4.745,P=0.000]; 时间因素和分组因素存在交互效应(F=32.478,P=0.000)。结论:强骨饮可增加股骨颈骨折患者人工股骨头置换术后股骨近端假体周围的骨密度。
Abstract:
Objective:To study the effect of QIANGGU DRINK on peri-prosthetic bone density after artificial femoral head in patients with femoral neck fractures.Methods:Seventy-eight patients with femoral neck fractures were randomly divided into observation group and control group according to the visit sequence,39 cases in each group.All of the patients in the 2 groups were treated with artificial femoral head replacement,and then they were treated with oral application of caltrate D tablets combined with QIANGGU DRINK and monotherapy of oral application of caltrate D tablets respectively.Postoperative hip function restoration were reviewed and compared between the 2 groups.The areas around artificial prosthesis stem were divided into 7 zones(R1~R7)and the bone density was measured in each zone and compared between the 2 groups at 1 week and 3 and 6 months after the surgery.Results:The surgery were performed successfully in all the patients and 74 patients were available for follow-up.Three patients lost to follow-up in observation group and one patient lost to follow-up in control group.The median follow-up period was 18.5 years(range,9-24 months).The pain were relieved and the function of the hip joint were recovered in all the patients.The hip performance were evaluated according to the Harris Hip Score and the results showed that there was no statistical difference between the 2 groups(87.5+/-7.6 vs 86.7+/-8.1 points,t=10.437,P=0.896).No complications such as prosthesis loosening were found in the two groups.There was statistical difference in the bone density between different time points in R1 zone(F=76.367,P=0.000),in other words,there was time effect.There was statistical difference in the bone density between the 2 groups(F=6.375,P=0.001),in other words,there was group effect.There was no statistical difference in the bone density between the 2 groups one week after the surgery(0.772+/-0.214 vs 0.761+/-0.178 g/cm(2); t=0.578,P=0.683).The bone density of observation group were higher than those of control group 3 and 6 months after the surgery(0.758+/-0.268 vs 0.602+/-0.244 g/cm(2); t=2.232,P=0.024; 0.732+/-0.227 vs 0.518+/-0.188 g/cm(2); t=2.847,P=0.004).There was interaction between time factor and grouping factor(F=36.726,P=0.000).There was no statistical difference in the bone density of R2~R6 zones(R2:1.532+/-0.342,1.478+/-0.451,1.432+/-0.403 g/cm(2); 1.613+/-0.268,1.582+/-0.265,1.533+/-0.275 g/cm(2).R3:1.746+/-0.276,1.641+/-0.324,1.615+/-0.327 g·cm(2); 1.692+/-0.312,1.634+/-0.403,1.589+/-0.157 g/cm(2).R4:1.831+/-0.302,1.768+/-0.256,1.711+/-0.236 g/cm(2); 1.798+/-0.275,1.735+/-0.358,1.636+/-0.326 g/cm(2).R5:1.736+/-0.257,1.677+/-0.389,1.632+/-0.324 g/cm(2); 1.812+/-0.362,1.752+/-0.265,1.698+/-0.424 g/cm(2).R6:1.563+/-0.352,1.612+/-0.327,1.578+/-0.367 g/cm(2); 1.642+/-0.279,1.598+/-0.278,1.504+/-0.276 g/cm(2))between different time points(F=2.468,P=0.162; F=1.569,P=0.453; F=1.862,P=0.358; F=3.556,P=0.112; F=4.065,P=0.104).There was no statistical difference in the bone density between the 2 groups(F=1.679,P=0.153; F=0.879,P=0.553; F=2.568,P=0.122:F=3.512,P=0.098; F=4.679,P=0.082).There was interaction between time factor and grouping factor(F=26.765,P=0.000; F=23.343,P=0.000; F=28.276,P=0.000; F=21.825,P=0.000; F=26.468,P=0.000).There was statistical difference in the bone density between different time points in R7 zone(F=52.828,P=0.000),in other words,there was time effect.There was statistical difference in the bone density between the 2 groups(F=12.476,P=0.000),in other words,there was grouping effect.There was no statistical difference in the bone density between the 2 groups at one week after the surgery(1.292+/-0.262 vs 1.203+/-0.322 g/cm(2); t=1.578,P=0.167).The bone density of observation group were higher than those of control group at three and six months after the surgery(1.178+/-0.345 vs 0.869+/-0.159 g/cm(2); t=3.025,P=0.002; 1.123+/-0.312 vs 0.752+/-0.328 g/cm(2); t=4.745,P=0.000).There was interaction between time factor and grouping factor(F=32.478,P=0.000).Conclusion:QIANGGU DRINK can increase proximal femoral peri-prosthetic bone density after artificial femoral head replacement in patients with femoral neck fractures.

参考文献/References:

[1] Pivec R,Johnson AJ,Mears SC,et al.Hip arthroplasty[J].Lancet,2012,380(9855):1768-1777.
[2] Sabokbar A,Kudo O,Athanasou NA.Two distinct cellular mechanisms of osteoclast formation and bone resorption inperiprosthetic osteolysis[J].J Orthop Res,2003,21(1):73-80.
[3] Catelas I,Jacobs JJ.Biologic activity of wear particles[J].Instr Course Lect,2010,59:3-16.
[4] 吴连国,刘康,王定,等.强骨饮治疗骨关节炎合并骨质疏松患者的临床研究[J].中国中医骨伤科杂志,2011,19(12):10-13.
[5] 吴连国,王定,朱彦昭,等.强骨饮治疗原发性骨质疏松症的临床研究[J].中国中医药科技,2009,16(3):167-168.
[6] Gruen TA,McNeice GM,Amstutz HC."Modes of failure"of cemented stem-type femoral components:a radiographic analysis of loosening[J].Clin Orthop Relat Res,1979,(141):17-27.
[7] Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by moldarthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51(4):737-755.
[8] Mulcahy H,Chew FS.Current concepts of hip arthroplasty for radiologists:part 2,revisions and complications[J].AJR Am J Roentgenol,2012,199(3):570-580.
[9] Mulliken BD,Bourne RB,Rorabeck CH,et al.A tapered titanium femoral stem inserted without cement in a total hip arthroplasty.Radiographic evaluation and stability[J].J Bone Joint Surg Am,1996,78(8):1214-1225.
[10] Engh CA Jr,McAuley JP,Sychterz CJ,et al.The accuracy and reproducibility of radiographic assessment of stress-shielding.Apostmortem analysis[J].J Bone Joint Surg Am,2000,82-A(10):1414-1420.
[11] Weinans H,Sumner DR,Igloria R,et al.Sensitivity of periprosthetic stress-shielding to load and the bone density-modulus relationship in subject-specific finite element models[J].J Biomech,2000,33(7):809-817.
[12] Gallinaro P,Massè A,Leonardi F,et al.Eight-to ten-year results of a variable geometry stem[J].Orthopedics,2007,30(11):954-958.
[13] 吴连国,陈华,史晓林,等.益气补肾温经法对去卵巢大鼠股骨颈骨形态计量学的影响[J].浙江中医药大学学报,2008,32(1):36-40.

相似文献/References:

[1]邢金明.切开复位锁定钢板内固定术和人工半肩关节置换术 治疗老年肱骨近端复杂骨折的对比研究[J].中医正骨,2015,27(08):11.
 XING Jinming.A retrospective trial of open reduction and locking plate internal fixation versus artificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):11.
[2]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[3]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[4]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[5]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[6]魏瑄,宋树春,王金良.术前精确测量和评估在全髋关节置换治疗 成人发育性髋关节发育不良继发骨关节炎中的价值[J].中医正骨,2015,27(01):30.
[7]鲍荣华,陈晓东,王国平,等.Wagner Cone生物型假体置换结合经股骨转子下横形截骨 治疗CroweⅣ型成人发育性髋关节发育不良[J].中医正骨,2015,27(01):33.
[8]喻长纯,杨明路,王战朝.同期髌骨脱位矫正术联合全膝关节置换术治疗 晚期膝骨关节炎合并习惯性髌骨脱位[J].中医正骨,2015,27(01):41.
[9]武理国,沈军,傅国海,等.人工肱骨头置换治疗老年肱骨近端复杂骨折[J].中医正骨,2013,25(10):70.
[10]李国梁,韩广普,闫国强,等.红花化瘀汤薰蒸联合理筋手法 在膝骨关节炎全膝关节置换术后康复中的应用[J].中医正骨,2013,25(12):31.
 Li Guoliang*,Han Guangpu,Yan Guoqiang,et al.Clinical application of HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipulation in the postoperative rehabilitation of total knee arthroplasty in patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(04):31.
[11]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[12]李翰林,童培建.利福平联合用药配合保留假体清创治疗 人工关节置换术后早期感染及低毒性感染[J].中医正骨,2015,27(09):56.
[13]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[14]张维平,康两期,陈卫,等.全髋关节置换术围手术期隐性失血的研究进展[J].中医正骨,2015,27(08):61.
[15]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[16]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[17]徐伟锋,叶健,吴连国.强骨饮对骨质疏松性股骨颈骨折患者全髋关节置换术后 血清骨代谢生化指标和骨密度的影响[J].中医正骨,2015,27(02):12.
 XU Weifeng,YE Jian,WU Lianguo.Effect of Qianggu Yin(强骨饮,QGY)on serum bone metabolism indexes and bone density after total hip arthroplasty in patients with osteoporotic femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(04):12.
[18]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[19]齐志远,陈秀民,王在斌,等.桃红四物加黄芪汤预防人工髋膝关节置换术后 下肢深静脉血栓形成[J].中医正骨,2015,27(03):71.
[20]陆吴超,季卫锋,马镇川.关节镜下清创后持续灌洗联合中药口服治疗 全膝关节置换术后急性期感染[J].中医正骨,2015,27(01):51.

备注/Memo

备注/Memo:
基金项目:中国博士后科学基金项目(2013M530290),国家中医药管理局2013年度中医药行业科研专项项目(201307010),浙江省自然科学基金资助项目(LY12H27013),浙江省医坛新秀培养对象资助项目(浙卫发2013-245号),浙江省博士后科研项目择优资助项目(BSH1302082),2013年浙江省医药卫生科技计划项目(2013KYA143)
更新日期/Last Update: 1900-01-01