唑来膦酸与地舒单抗对髋关节置换术后患者侧髋关节骨密度及关节功能的影响

Effects of zoledronic acid and denosumab on bone mineral density and function of the lateral hip joint after hip replacement

摘要:

目的 评估唑来膦酸与地舒单抗对髋关节置换术后患者侧髋关节骨密度及关节功能的影响。方法 选取2020年1月—2022年12月在天津市天津医院进行髋关节置换术的100例患者。按照分层随机抽样法将患者分为对照组和试验组，每组50例。对照组在术后接受唑来膦酸治疗，试验组在术后接受地舒单抗治疗。对比两组骨代谢指标［Ⅰ型胶原羧基端肽β特殊序列（β-CTX）、骨形成标志物骨钙素（BGP）、I型前胶原羧基末端肽（PICP）、骨特异性碱性磷酸酶（BALP）］、骨形成吸收标志物［胰岛素样生长因子-1（IGF-1）、性激素结合蛋白（SHBG）、脱氧吡啶酚（DPD）］、侧髋关节骨密度、假体松动率、关节功能［（Harris）髋关节评分］、假体移位距离的差异。结果 试验组手术前后β-CTX、BGP、PICP、BALP、IGF-1、SHBG、DPD的差值均高于对照组（P <0.05）。试验组与对照组术后1、3、6和12个月的侧髋关节骨密度、髋臼杯内移、髋臼杯上移、股骨柄下沉比较，结果 ①不同时间点侧髋关节骨密度、髋臼杯内移、髋臼杯上移、股骨柄下沉比较，差异均有统计学意义（P <0.05）。②试验组与对照组侧髋关节骨密度、髋臼杯内移、髋臼杯上移比较，差异均有统计学意义（P <0.05），试验组侧髋关节骨密度较高，髋臼杯内移、髋臼杯上移距离较短；试验组与对照组股骨柄下沉比较，差异无统计学意义（P >0.05）。③两组侧髋关节骨密度、髋臼杯内移、髋臼杯上移变化趋势比较，差异均有统计学意义（P <0.05）；两组股骨柄下沉变化趋势比较，差异无统计学意义（P >0.05）。试验组与对照组术后3、6、12个月的假体松动率比较，差异均无统计学意义（P >0.05）。试验组手术前后疼痛、功能、畸形、关节活动度和总分的差值均高于对照组（P <0.05）。结论 髋关节置换术后使用地舒单抗较唑来膦酸能更有效地提高侧髋关节骨密度，改善关节功能，显示了地舒单抗在术后管理中的潜在优势。

Abstract:

Objective To assess the effects of zoledronic acid and denosumab on bone mineral density and function of the lateral hip joint after hip replacement.Methods A total of 100 patients who underwent hip replacement in Tianjin Hospital from January 2020 to December 2022 were selected. Patients were divided into a control group and an experimental group via stratified random sampling, with 50 cases in each group. The control group received zoledronic acid postoperatively, and the experimental group received denosumab postoperatively. The two groups were compared in terms of bone metabolism indicators [C-terminal telopeptide of type I collagen (β-CTX), bone Gla protein (BGP), procollagen type I C-terminal propeptide (PICP), and bone-specific alkaline phosphatase (BALP)], bone formation and resorption markers [insulin-like growth factor-1 (IGF-1), sex hormone-binding globulin (SHBG), and deoxypyridinoline (DPD) ], bone mineral density of the lateral hip joint, the rate of prosthesis loosening, hip joint function (Harris Hip Score), and displacement distance of the prosthesis.Results The differences in levels of β-CTX, BGP, PICP, BALP, IGF-1, SHBG, and DPD before and after surgery were higher in the experimental group than those in the control group (P < 0.05). Comparisons of the bone mineral density of the lateral hip joint, medial migration of the acetabular cup, superior migration of the acetabular cup, and femoral stem subsidence at 1 month, 3 months, 6 months, and 12 months after surgery in the experimental group and the control group showed that they were all different among the time points (P < 0.05). The bone mineral density of the lateral hip joint, medial migration of the acetabular cup, and superior migration of the acetabular cup were different between the experimental group and the control group (P < 0.05), where the bone mineral density of the lateral hip joint was higher and the distances of medial and superior migration of the acetabular cup were shorter in the experimental group than in the control group. There was no difference in the femoral stem subsidence between the two groups (P >0.05). The change trends of the bone mineral density of the lateral hip joint, medial migration of the acetabular cup, and superior migration of the acetabular cup were different between the two groups (P < 0.05). There was no significant difference in the change trend of the femoral stem subsidence between the two groups (P > 0.05). No significant difference was found in the rate of prosthesis loosening at 3 months, 6 months, and 12 months after surgery between the experimental group and the control groups (P > 0.05). The differences of pain severity, function, absence of deformity, and range of motion subitem scores as well as total scores before and after surgery were higher in the experimental group than in the control group (P < 0.05).Conclusions Denosumab is more effective than zoledronic acid in improving bone mineral density and function of the lateral hip joint after hip replacement, highlighting the potential advantages of denosumab in postoperative management.