鲑鱼降钙素对老年骨科手术后患者骨代谢的影响

目的：观察老年患者骨科围术期骨代谢变化特点及术后应用鲑鱼降钙素对骨代谢的影响。方法年龄＞60岁老年患者90例纳入本研究，男性21例，女性69例。其中行髋关节手术37例，膝关节手术38例，腰椎手术15例。将研究对象随机分为2组，治疗组45例，术后应用鲑鱼降钙素＋碳酸钙片＋活性维生素D抗骨质疏松治疗；对照组45例，术后应用碳酸钙片＋活性维生素D治疗。分别于术前、术后1周、术后3个月测定静脉血骨钙素（OC）及Ⅰ型胶原交联C端肽（β-CTX）水平；于术前、术后3个月采用DEXA双能X线骨密度仪测定患者腰椎及髋部骨密度。结果共78例患者完成随访，对照组（n＝37）术后1周β-CTX均值较术前明显升高（P＜0.001），术后3个月较术前变化无统计学意义（P＞0.05）；治疗组（n＝41）术后1周β-CTX均值较术前明显升高（P＜0.001），术后3个月较术前明显降低（P＜0.05）；对照组术后1周OC均值较术前明显降低（P＜0.05），术后3个月较术前无明显变化（P＞0.05）；治疗组术后1周OC均值较术前明显降低（P＜0.001），术后3个月较术前无明显变化（P＞0.05）；治疗组与对照组腰椎、髋部BMD术前与术后3个月差异均无统计学意义（均P＞0.05）。结论老年患者接受骨科手术前后骨代谢发生改变，手术后1周骨吸收过程活跃，骨形成过程受抑制；术后应用鲑鱼降钙素3个月抗骨质疏松治疗能有效抑制骨吸收，但对促进骨形成无明显影响。

Effect of salmon calcitonin in edderly people after orthopaedic operation on bone metabolism

Objective To observe the changes of bone metabolism of elderly people , and the effect of anti-oste-oporosis treatment to bone metabolism during orthopaedic perioperative period. Methods 90 patients （21 males and 69 females, 60 -89 years old） were selected into randomized clinically controlled trial .The treatment group （ n=45 ） re-ceived salmon calcitonin , calcium carbonate and active vitamin D to anti-osteoporosis treatment; the control （ n =45 ） group received calcium carbonate and active vitamin D only .Osteocalcin （ OC） , C-terminal Telopeptides of Type I colla-gen （β-CTX） in serum were measured by ECLIA in all patients preoperatively , 1 week after operation and 3 months after operation.Bone mineral density （BMD） were measured by dual-energy X-ray densitometer preoperatively and 3 months after operation .β-CTX, OC and BMD were compared before and after operation .Results 78 patients completed the study.The β-CTX level increased 1 week postoperatively （P〈0.001） and did not change significantly 3 months postop-eratively （ P〉0.05 ） in the control group;theβ-CTX level increased 1 week postoperatively （ P〈0.001 ） but decreased significantly 3 months postoperatively （ P〈0.05 ） in the treatment group .The OC level decreased 1 week postoperatively （ P〈0.05 ） and did not change significantly 3 months postoperatively （ P〉0.05 ） in the control group;the OC level de-creased 1 week postoperatively （ P〈0.001 ） and did not change significantly 3 months postoperatively （ P〉0.05 ） in the treatment group .There was no significant difference between the mean BMD in lumber and hip before and 3 months after operation in each group （ P〉0.05 ） .Conclusion The elderly patients had bone metabolism changes before and after or-thopedic operation .In a relatively short time after operation （1 week） , the postoperative β-CTX was higher than preoper-ative, suggesting that bone resorption increased after operation;the postoperative OC was lower than p