Maloney W J, Sychterz C, Bragdon C, McGovern T, Jasty M, Engh C A, Harris W H
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Clin Orthop Relat Res. 1996 Dec(333):15-26.
Previous studies evaluating femoral remodeling after total hip arthroplasty have used clinical radiographs and dual energy xray absorptiometry. Limitation of these techniques make it impossible to quantify the magnitude of bone loss in terms of cortical thinning and cortical bone area and bone mineral density changes. Femoral cortical bone remodeling after cemented and cementless replacement was quantified and possible determinants of bone remodeling in terms of clinical and radiographic variables were evaluated. Forty-eight anatomic specimen femora from 24 patients with unilateral cemented and cementless hip replacements were analyzed. Cortical thickness, cortical bone area, and bone mineral density was assessed in 4 quadrants at 5 discrete levels. The maximum cortical bone loss by level was at the middle section for the cemented femurs and at the midproximal and middle sections for the cementless femurs. However, if one examines individual quadrants, the proximal medial cortex still represents the specific region of maximal bone loss for both types of implant fixation. The posterior cortex had substantially more bone loss, even in the diaphyseal levels, than had been previously appreciated. A strong correlation was noted between the bone mineral density of the control femur and the percentage decrease of bone mineral density in the remodeled femur. Based on this data, it seems that the less dense the bone is before hip replacement surgery, the greater the extent of bone loss after total hip arthroplasty regardless of the fixation type.
以往评估全髋关节置换术后股骨重塑的研究使用了临床X线片和双能X线吸收法。这些技术的局限性使得无法根据皮质变薄、皮质骨面积和骨矿物质密度变化来量化骨质流失的程度。对骨水泥型和非骨水泥型置换术后的股骨皮质骨重塑进行了量化，并根据临床和影像学变量评估了骨重塑的可能决定因素。分析了24例单侧骨水泥型和非骨水泥型髋关节置换患者的48个解剖标本股骨。在5个离散水平的4个象限中评估皮质厚度、皮质骨面积和骨矿物质密度。骨水泥型股骨各水平的最大皮质骨丢失位于中段，非骨水泥型股骨位于近端中段和中段。然而，如果检查单个象限，近端内侧皮质仍然是两种植入物固定方式下最大骨质流失的特定区域。即使在骨干水平，后皮质的骨质流失也比之前认识到的要多得多。对照股骨的骨矿物质密度与重塑股骨的骨矿物质密度降低百分比之间存在很强的相关性。基于这些数据，似乎髋关节置换手术前骨质密度越低，全髋关节置换术后骨质流失的程度就越大，无论固定类型如何。
