假体周围骨重塑的骨密度测定评估
Densitometric evaluation of periprosthetic bone remodeling.
作者信息
Parchi Paolo Domenico, Cervi Valentina, Piolanti Nicola, Ciapini Gianluca, Andreani Lorenzo, Castellini Iacopo, Poggetti Andrea, Lisanti Michele
机构信息
1st Orthopedic Division, Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy.
出版信息
Clin Cases Miner Bone Metab. 2014 Sep;11(3):226-31.
Abstract
The application of Dual-energy X-ray absorptiometry (DEXA) in orthopaedic surgery gradually has been extended from the study of osteoporosis to different areas of interest like the study of the relation between bone and prosthetic implants. Aim of this review is to analyze changes that occur in periprosthetic bone after the implantation of a total hip arthroplasty (THA) or a total knee arthroplasty (TKA). In THA the pattern of adaptive bone remodeling with different cementless femoral stems varies and it appears to be strictly related to the design and more specifically to where the femoral stem is fixed on bone. Short stems with metaphyseal fixation allow the maintenance of a more physiologic load transfer to the proximal femur decreasing the entity of bone loss. Femoral bone loss after TKA seems to be related to the stress shielding induced by the implants while tibial bone remodeling seems to be related to postoperative changes in knee alignment (varus/valgus) and consequently in tibial load transfer. After both THA and TKA stress shielding seems to be an inevitable phenomenon that occurs mainly in the first year after surgery.
摘要
双能X线吸收法（DEXA）在骨科手术中的应用已逐渐从骨质疏松症的研究扩展到不同的感兴趣领域，如骨与假体植入物之间关系的研究。本综述的目的是分析全髋关节置换术（THA）或全膝关节置换术（TKA）植入后假体周围骨发生的变化。在THA中，不同非骨水泥型股骨干的适应性骨重塑模式各不相同，且似乎与设计密切相关，更具体地说，与股骨干在骨上的固定位置有关。采用干骺端固定的短柄假体能够维持向股骨近端更生理性的负荷传递，减少骨质流失。TKA后的股骨骨质流失似乎与植入物引起的应力遮挡有关，而胫骨骨重塑似乎与术后膝关节对线（内翻/外翻）的变化以及随之而来的胫骨负荷传递有关。在THA和TKA后，应力遮挡似乎都是一种不可避免的现象，主要发生在术后第一年。
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本文引用的文献
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J Bone Miner Metab. 2014 Sep;32(5):539-44. doi: 10.1007/s00774-013-0526-x.
2
A prospective dual-energy X-ray absorptiometry study of bone remodeling after implantation of the Nanos short-stemmed prosthesis.一项关于纳米短柄假体植入后骨重塑的前瞻性双能X线吸收法研究。
Acta Orthop Belg. 2013 Apr;79(2):174-80.
3
A prospective cohort study on the short collum femoris-preserving (CFP) stem using RSA and DXA. Primary stability but no prevention of proximal bone loss in 27 patients followed for 2 years.采用 RSA 和 DXA 对短股骨颈保留（CFP）干进行前瞻性队列研究。在 27 例患者中随访 2 年，仅观察到初始稳定性，而不能预防近端骨丢失。
Acta Orthop. 2013 Feb;84(1):32-9. doi: 10.3109/17453674.2013.765623. Epub 2013 Jan 23.
4
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Int Orthop. 2013 Mar;37(3):369-77. doi: 10.1007/s00264-012-1725-0. Epub 2012 Dec 28.
5
Periprosthetic bone mineral density changes after unicondylar knee arthroplasty.单髁膝关节置换术后假体周围骨密度变化
Knee. 2013 Mar;20(2):120-7. doi: 10.1016/j.knee.2012.10.004. Epub 2012 Nov 13.
6
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Arch Orthop Trauma Surg. 2012 Aug;132(8):1111-9. doi: 10.1007/s00402-012-1537-0. Epub 2012 May 24.
7
Ibandronate and periprosthetic bone mass: new therapeutic approach in periprosthetic loosening prevention.伊班膦酸盐与假体周围骨量：预防假体周围松动的新治疗方法。
Clin Cases Miner Bone Metab. 2011 Jan;8(1):55-6.
8
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Clin Orthop Relat Res. 2012 May;470(5):1431-5. doi: 10.1007/s11999-011-2134-1. Epub 2011 Oct 21.
9
Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study.髋关节置换术中 Metha 短柄周围的骨重建：一项前瞻性双能 X 射线吸收法研究。
Int Orthop. 2012 Mar;36(3):533-8. doi: 10.1007/s00264-011-1361-0. Epub 2011 Sep 21.
10
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