目的 观察鲑鱼降钙素联合维生素D全髋关节置换术后抗骨质疏松的疗效.方法 选择2013年7月至2015年3月解放军第一〇一医院收治的80例接受全髋关节置换术患者为研究对象,按抽签法将患者分为联合治疗组和维生素D组,每组40例.维生素D组患者在接受常规镇痛治疗的基础上口服维生素D抗骨质疏松治疗(800 U/次,口服);联合治疗组在维生素D组的基础上接受鲑鱼降钙素治疗(50 U/次,肌内注射),比较两组患者术前、术后3 d、7 d、10 d、2周时的视觉模拟评分(VAS)以及术前、术后1周、2周时Harris评分和髋部骨密度.结果 两组患者术前、术后3 d、术后7 d、术后10 d及术后2周时VAS[维生素D组(8.5±2.4)分、(7.2±0.8)分、(7.1±1.0)分、(4.3±1.4)分、(3.6±1.1)分,联合治疗组(8.5±2.3)分、(7.0±1.1)分、(6.0±1.3)分、(3.5±1.0)分、(2.9±1.0)分]均逐渐降低,但联合治疗组患者的VAS较维生素D组更低,在组间、时点间以及组间· 时点间交互作用比较差异有统计学意义(P<0.05).两组患者术前、术后1周及2周时Harris评分以及骨密度[Harris评分:维生素D组(52.5±13.9)分、(67.9±8.5)分、(74.8±6.4)分,联合治疗组(52.7±13.5)分、(74.7±6.9)分、(81.8±5.6)分;骨密度:维生素D组(0.73±0.23)g/cm2、(0.81±0.22)g/cm2、(0.83±0.24)g/cm2,联合治疗组(0.72±0.21)g/cm2、(0.86±0.24)g/cm2、(0.96±0.28)g/cm2]均逐渐升高,其中联合治疗组的Harris评分及骨密度均较维生素D组更高,在组间、时点间以及组间· 时点间交互作用比较,差异有统计学意义(P<0.05).结论 全髋关节置换术后应用鲑鱼降钙素联合维生素D抗骨质疏松的疗效显著,可以有效缓解患者术后疼痛,提高骨密度,更好地恢复关节功能.%Objective To study the anti-osteoporosis effect of salmon calcitonin combined with vitamin D after total hip replacement .Methods A total of 80 patients who received total hip replacement in People′s Liberation Army 101 Hospital from Jul.2013 to Mar.2015 were included in the study ,and divided into a combination group and vitamin D group according to sortation method,40 cases in each group.The vitamin D group received vitamin D (800 U/time,oral) on the basis of con-ventional analgesic therapy for anti-osteoporosis.On the basis of vitamin D group′s regimen,the combination group received salmon calcitonin treatment(50 U/time,intramscular injection).The VAS of the two groups were compared before operation and 3 d,7 d,10 d,2 weeks after operation ,and the Harris score as well as hip bone density of the two groups were compared before operation and 1 week,2 weeks after operation .Results The VAS before operation and 3 d,7 d,10 d,2 weeks after operation of the combination group were significantly lower than the vitamin D group between groups ,different time points and groups· time points[vitamin D group (8.5 ±2.4)score,(7.2 ±0.8) score,(7.1 ±1.0) score,(4.3 ±1.4) score, (3.6 ±1.1) score vs combination group (8.5 ±2.3) score,(7.0 ±1.1) score,(6.0 ±1.3) score,(3.5 ±1.0) score, (2.9 ±1.0) score,P<0.05].The Harris scores of the combination group were significantly better than the vitamin D group[vitamin D group (52.5 ±13.9) score,(67.9 ±8.5) score,(74.8 ±6.4) score vs combination group (52.7 ±13.5) score,(74.7 ±6.9) score,(81.8 ±5.6) score,P<0.05].The bone density of the combination group was signifi-cantly higher than the vitamin D group [ vitamin D group (0.73 ±0.23) g/cm2 ,(0.81 ±0.22) g/cm2 ,(0.83 ±0.24) g/cm2 vs combination group (0.72 ±0.21) g/cm2,(0.86 ±0.24) g/cm2,(0.96 ±0.28) g/cm2,P<0.05].After operation,the Harris scores and bone density of both groups were increased ,and the combination group was higher than vitamin D group . Conclusion The clinical effect of salmon calcitonin combined with vitamin D for treatment of osteoporosis after total hip replacement is significant , which can effectively relieve postoperative pain and improve the bone density , realizing better recovery of the joint function .
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