解剖型生物固定股骨柄假体周围骨密度的中短期随访研究

A short to midterm follow-up of periprosthetic BMD after total hip arthroplasty with the anatomic cementless femoral stem

摘要:

目的：研究应用解剖型生物固定股骨柄假体行全髋关节置换（total hip arthroplasty，THA）的患者术后中短期随访时假体周围骨密度变化，为假体设计、改进提供理论参考。方法：门诊随访采用Ribbed股骨柄行初次单侧THA 1年以上的患者。采用双能X线对假体周围及非手术侧相应7个感兴趣区（region of interest，ROI） 进行骨密度（bone mineral density，BMD）测定，对比分析。结果：随访28例患者，平均随访时间为35.5月。与非手术侧相比，假体周围ROI 1、2、3、5、6、7区BMD未见明显差异，仅ROI 4区差异有统计学意义[手术侧BMD（1.58±0.28） g/cm2，非手术侧BMD（1.66±0.20） g/cm2；t=-2.216，P=0.035]。结论：采用解剖型生物固定Ribbed股骨柄假体行THA的患者，假体周围骨长入达到生物固定效果，术后股骨侧应力比较符合正常生理传导，其特点在未来假体设计时可供借鉴。

Abstract:

Objective：To explore the periprosthetic bone mineral density（BMD） changes in patients undergoing total hip arthroplasty（THA） with the anatomic cementless femoral stem during the short to midterm follow-up period，and to provide a theoretical frame－work for prosthesis design in the future. Methods：A total of 28 patients undergone primary unilateral cementless THA（T.O.P. hip ac－etabular cup/Ribbed stem，Link） more than one years were chosen and followed in the study. Periprosthetic and contralateral bone mineral density（BMD） in seven Gruen zones was measured with dual energy X-ray absorptiometry（DEXA）. These data were ana－lyzed subsequently using SPSS software. Results：Twenty-eight patients who underwent THA during April 2010 and January 2015 with an average follow-up of 35.5 months were included in this study，of which 13 were males and 15 were females，at a mean age of （61.36±9.40） years（range，41-75 years）. Their body mass index was （24.78±2.80） kg/m2. The disease spectrum leading to primary THA consist of vascular necrosis of the femoral head（10 cases），developmental dysplasia of the hip（8 cases），femoral neck fractures （6 cases），and hip osteoarthritis（4 cases）. Periprosthetic BMD changes were most pronounced only in the distal Gruen zone 4[surgi－cal side BMD（1.58±0.28） g/cm2，non-operated control side BMD（1.66±0.20） g/cm2；t=-2.216，P=0.035]，and no significant differ－ences were detected when compared with the non-operated control side in other Gruen zones. Conclusion：The Ribbed anatomic cementless femoral stem contributes to periprosthetic bone ingrowth in patients undergoing THA，proximal load transfer comparatively approximates normal bio-stress，the features of which are well worth learning from in the future.