补肾活血法防治绝经女性全膝关节置换术后假体周围骨丢失的研究
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摘要
目的观察绝经女性全膝关节置换术后假体周围骨丢失的规律,探讨补肾活血法防治肾虚血瘀型绝经后膝关节置换术患者假体周围骨丢失的效果。方法将60例肾虚血瘀型绝经女性膝骨关节炎行全膝关节置换术的患者随机分为治疗组和对照组,每组30例。对照组术后给予骨化三醇胶丸+钙尔奇D片口服,治疗组给予补肾活血中药龙鳖胶囊+骨化三醇胶丸+钙尔奇D片口服,2组均连续治疗3个月。分别于术后1周、3个月、6个月、9个月,采用双能X射线骨密度仪检测2组患者膝关节假体周围的骨密度。结果 2组术后3个月、6个月、9个月时股骨假体上方远端兴趣区(ROI 1区)、胫骨假体下方近端兴趣区(ROI 2区)的骨密度均明显低于术后1周(P均<0.05),且骨密度均呈进行性降低,其中术后前3个月下降较为明显,术后6～9个月下降趋缓;治疗组术后6个月、9个月时ROI 1区骨密度和术后3个月、6个月、9个月时ROI 2区骨密度均明显高于对照组(P均<0.05)。结论绝经后女性全膝关节置换术后假体周围骨量在术后前6个月呈快速下降趋势,术后6～9个月下降趋于平缓。补肾活血中药配合抗骨质疏松药物可以有效防治肾虚血瘀型绝经后膝关节置换术患者假体周围骨丢失。
Objective It is to observe the law of bone loss around the prosthesis after total knee arthroplasty in menopausal women, and to explore the effect of Bushen Huoxue method on prevention and treatment of bone loss around the prosthesis in patients with post-menopausal knee joint replacement. Methods Sixty menopausal patients with knee osteoarthritis of type of kidney deficiency and blood stasis who underwent total knee arthroplasty were randomly divided into treatment group and control group, 30 cases in each group. The patients in the control group were given calcitriol capsules + Calcium D tablets orally, and the treatment group was additionally treated with Longbie capsule for oral administration on the basis of therapy in the control group. Both groups were treated for 3 months. Bone mineral density around the knee joint prosthesis of the 2 groups was measured by dual-energy X-ray absorptiometry at 1 week, 3 months, 6 months, and 9 months after surgery. Results The bone mineral density in the distal interest area of upper part of the femoral component(ROI area 1) and the proximal interest area(ROI 2 area) of the tibial component in the 2 groups at 3 months, 6 months and 9 months after operation were significantly lower than those at 1 week after operation(P<0.05), and bone mineral density showed progressive decline, which decreased significantly in the first 3 months after surgery, and slowed down after 6 to 9 months after operation. The bone mineral density in ROI area 1 at 6 months, 9 months after surgery and the bone mineral density in ROI area 2 at 3 months, 6 months and 9 months after operation were significantly higher than those in the control group(P<0.05). Conclusion The total bone mass of the prosthesis in postmenopausal women after total knee arthroplasty showed a rapid decline in the first 6 months after surgery, and the decline was smoother in 6 to 9 months after operation. Chinese herbal medicine for invigorating kidney and promoting blood circulation combined with anti-osteoporosis drugs can effectively prevent bone loss around the prosthesis in patients with syndrome of kidney deficiency and blood stasis undergoing post-menopausal knee joint replacement.
Objective It is to observe the law of bone loss around the prosthesis after total knee arthroplasty in menopausal women, and to explore the effect of Bushen Huoxue method on prevention and treatment of bone loss around the prosthesis in patients with post-menopausal knee joint replacement. Methods Sixty menopausal patients with knee osteoarthritis of type of kidney deficiency and blood stasis who underwent total knee arthroplasty were randomly divided into treatment group and control group, 30 cases in each group. The patients in the control group were given calcitriol capsules + Calcium D tablets orally, and the treatment group was additionally treated with Longbie capsule for oral administration on the basis of therapy in the control group. Both groups were treated for 3 months. Bone mineral density around the knee joint prosthesis of the 2 groups was measured by dual-energy X-ray absorptiometry at 1 week, 3 months, 6 months, and 9 months after surgery. Results The bone mineral density in the distal interest area of upper part of the femoral component(ROI area 1) and the proximal interest area(ROI 2 area) of the tibial component in the 2 groups at 3 months, 6 months and 9 months after operation were significantly lower than those at 1 week after operation(P<0.05), and bone mineral density showed progressive decline, which decreased significantly in the first 3 months after surgery, and slowed down after 6 to 9 months after operation. The bone mineral density in ROI area 1 at 6 months, 9 months after surgery and the bone mineral density in ROI area 2 at 3 months, 6 months and 9 months after operation were significantly higher than those in the control group(P<0.05). Conclusion The total bone mass of the prosthesis in postmenopausal women after total knee arthroplasty showed a rapid decline in the first 6 months after surgery, and the decline was smoother in 6 to 9 months after operation. Chinese herbal medicine for invigorating kidney and promoting blood circulation combined with anti-osteoporosis drugs can effectively prevent bone loss around the prosthesis in patients with syndrome of kidney deficiency and blood stasis undergoing post-menopausal knee joint replacement.
引文
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[13] 王春昕,赵颖,张妍.六味地黄丸对生物型全髋置换术后髋臼假体周围骨密度的影响[J].现代中西医结合杂志,2016,25(27):3027-3030
[14] 葛永潮,杨康.益肾祛瘀壮骨中药治疗无菌性股骨头坏死疗效及对骨密度的影响[J].现代中西医结合杂志,2017,26(13):1423-1425
[15] 葛满意,段泽敏,郭艳宇,等.阿法骨化醇联合补肾活血法对老年女性骨质疏松性髋部骨折骨代谢和骨密度的影响[J].现代中西医结合杂志,2018,27(17):1915-1918
[16] 谢辉.补肾活血中药对膝骨关节炎免疫微环境的调控作用及其机制研究[D].广州:广州中医药大学,2017
[17] 潘建科.补肾活血中药治疗膝骨关节炎的循证、临床及实验研究[D].广州:广州中医药大学,2016
[18] 李永津,林涌鹏,侯宇,等.龙鳖胶囊与骨髓间充质干细胞移植对膝骨关节炎大鼠软骨修复作用的比较研究[J].广州中医药大学学报,2018,35(1):123-128
[2] 杨伟铭,赵彩琼,潘三元,等.膝骨性关节炎患者膝关节局部骨密度的差异性研究[J].中国骨质疏松杂志,2017,23(6):772-777
[3] Soininvaara TA,Miettinen HJ,Jurvelin JS,et al.Periprosthetic femoral bone loss after total knee arthroplasty:1-year follow-up study of 69 patients[J].Knee,2004,11(4):297-302
[4] Lavernia CJ,Rodriguez JA,Iacobelli DA,et al.Bone mineral density of the femur in autopsy retrieved total knee arthroplasties[J].J Arthroplasty,2014,29(8):1681-1686
[5] 郭世绂.废用性骨质疏松症[J].中华骨质疏松和骨矿盐疾病杂志,2008,1(2):81-84
[6] 卢伟杰,廖威明,余楠生,等.松动人工髋关节界膜的免疫组化研究[J].中国医师进修杂志,2006,29(5):34-36
[7] Baumann B,Rader CP,Seufert J,et al.Effects of polyethylene and TiAlV wear particles on expression of RANK,RANKL and OPG mRNA[J].Acta Orthop Scand,2004,75(3):295-302
[8] 蔡贤华,陈安民,石晓兵.不同浓度钛微粒对护骨素/护骨素配体基因表达影响的体外研究[J].中国矫形外科杂志,2005,13(5):368-371
[9] Zreiqat H,Crotti TN,Howlett CR,et al.Prosthetic particles modify the expression of bone-related proteins by human osteoblastic cells in vitro[J].Biomaterials,2003,24(2):337-346
[10] 杨志华,莫坚,王大伟.人工关节后期无菌性松动的研究进展[J].中医正骨,2007,19(5):68-70
[11] Tucker KL.Osteoporosis prevention and nutrition[J].Current Osteoporosis Reports,2009,7(4):111-117
[12] 刘芳,黄海,邓伟民,等.从骨质疏松骨小梁微血管变化剖析瘀血疼痛的基础[J].中国老年学杂志,2011,31(5):750-752
[13] 王春昕,赵颖,张妍.六味地黄丸对生物型全髋置换术后髋臼假体周围骨密度的影响[J].现代中西医结合杂志,2016,25(27):3027-3030
[14] 葛永潮,杨康.益肾祛瘀壮骨中药治疗无菌性股骨头坏死疗效及对骨密度的影响[J].现代中西医结合杂志,2017,26(13):1423-1425
[15] 葛满意,段泽敏,郭艳宇,等.阿法骨化醇联合补肾活血法对老年女性骨质疏松性髋部骨折骨代谢和骨密度的影响[J].现代中西医结合杂志,2018,27(17):1915-1918
[16] 谢辉.补肾活血中药对膝骨关节炎免疫微环境的调控作用及其机制研究[D].广州:广州中医药大学,2017
[17] 潘建科.补肾活血中药治疗膝骨关节炎的循证、临床及实验研究[D].广州:广州中医药大学,2016
[18] 李永津,林涌鹏,侯宇,等.龙鳖胶囊与骨髓间充质干细胞移植对膝骨关节炎大鼠软骨修复作用的比较研究[J].广州中医药大学学报,2018,35(1):123-128