【人工髋关节翻修病人假体周围骨密度的变化】 髋关节翻修假体

来源:数学教案 发布时间:2019-07-05 17:58:13 点击:

【摘要】 使用双能X线骨密度仪(DEXA)测量9例人工髋关节翻修病人股骨近端假体周围骨密度,了解人工髋关节翻修病人假体周围骨丢失情况。[方法]因假体松动而接受初次人工全髋关节翻修手术病人9例,用双能X线骨密度仪(DEXA)对比测量双侧股骨近端骨密度, 测量区域的划分采用Gruen七区法。术前临床评估以Harris髋关节评分(HHS)为标准。[结果]9例病人HHS评分61分,DEXA测量结果发现所有病人手术侧骨密度较非手术侧均出现明显下降, 范围在 8.9%~27.6%, 平均15.4%,下降有统计学意义(P<0.05)。[结论]人工髋关节置换术后早中期失败的病人,股骨近端假体周围骨丢失明显。

【关键词】 人工髋关节翻修术 骨丢失 骨密度 双能X线骨密度仪

Abstract: [Objective]To understand the changes of periprosthetic bone mineral density (BMD) of the proximal femur in patients with failed hip arthroplasty by measuring with dual energy X-ray absorptiometry (DEXA). [Method]Periprosthetic BMD was determined in 9 patients with revision total hip arthroplasty by dual energy X-ray absorptiometry (DEXA), defining regions of interest according to Gruen(1~7), and comparing the operation side with the nonoperation side. Clinic results of the cases were evaluated according to Harris Hip Score(HHS).[Result]The mean HHS was 61 points in 9 patients at this follow-up examination. There was a significant decrease (8.9%~27.6 % ) in BMD in every Gruen zone as compared with the nonoperation side.[Conclusion]The bone loss in the proximal femur in patients with failed hip arthroplasty is significant, and the pattern of bone loss around failed hip arthroplasty may be different from the typical remodeling seen after successful hip arthroplasty.

Key words:revision hip arthroplasty; bone lost; bone mineral density; dual energy X-ray absorptiometry

人工髋关节置换术后股骨近端假体周围会发生骨丢失。研究认为假体周围骨丢失、假体松动与假体周围的应力遮挡效应(stress shielding)和磨损碎屑引起的骨溶解(osteolysis)有关[1]。双能X线骨密度仪(DEXA)可以量化测量假体周围骨密度变化,精确且有很高的可重复性[2]。本研究使用DEXA对9例髋关节翻修病人股骨近端假体周围骨密度进行测量,以了解假体松动病人股骨近端假体周围骨丢失的变化情况。

1 资料和方法

1.1 一般资料

自2006年6月~2007年4月9例因人工髋关节假体松动在本院行初次人工髋关节翻修病人,男性3例,女性6例;平均年龄77岁(63~88岁)。病人均在外院行人工髋关节手术,其中单极股骨头置换1例,双极股骨头5例,全髋关节置换3例。骨水泥型2例,非骨水泥型7例。初次置换距翻修手术的时间平均为7年(3~10年)。初次人工关节置换的原因中骨折6例,股骨头无菌性坏死2例,髋关节发育不良1例。

1.2 研究方法

入院后由同一医生进行髋关节评分(HHS),并进行X线检查, 假体的稳定性按照假体下沉的程度和出现放射透亮区的数目[3]进行评估。假体松动是指术后6个月假体下沉超过3 mm或虽然没有下沉但是放射透亮区超过Gruen 4个区以上。

由同一医生用DEXA(GE公司,美国)测量骨密度。病人仰卧,两侧下肢对称的处于内旋位,双脚尖并拢,保持髌骨处于中立位。扫描从股骨大转子最高点上2 cm开始到假体柄尾端为止。像素为0.6 mm×1.2 mm。非手术侧股骨作为对照。

用专用骨科软件系统对所测得的骨密度进行

[3] Gruen TA, McNeice GM, Amstutz HC .“Modes of failures” of cemented stem-type femoral components: a radiographic analysis of loosening[J]. Clin Orthop, 1979,141:17-27.

[4] Karachalios T, Tsatsaronis C, Efraimis G, et al. The long-term clinical relevance of calcar atrophy caused by stress shielding in total hip arthroplasty: a 10-year prospective randomized study[J]. J Arthroplasty,2004,19:469-475.

[5] Engh CA Jr, Young AM, Engh CA Sr, et al. Clinical consequences of stress-shielding after porous-coated hip arthroplasty: a mean 14 year follow-up[J]. Clin Orthop Relat Res,2003,417:157-163.

[6] 马立峰,郭艾.双膦酸盐对人工髋关节置换术后早期假体周围骨密度的影响[J].中国矫形外科杂志,2007,4:270-271.

[7] 王裕民,李欣,王莉,等.骨水泥型I期全髋关节置换术后假体周围骨质丢失的早期研究[J].中国矫形外科杂志,2006,15:1172-1175.

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