Reiter A, Sabo D, Simank H G, Büchner T, Seidel M, Lukoschek M
Orthopädische Universitätsklinik Heidelberg.
Z Orthop Ihre Grenzgeb. 1997 Nov-Dec;135(6):499-504. doi: 10.1055/s-2008-1039735.
We analysed the periprosthetic bone mineral density (BMD) in a prospective longitudinal study over two years after operation and in a separate cross-sectional study more than five years after implantation of cementless total hip arthroplasty (CLS-stem, Mecron threaded acetabular cup) by using dual-energy X-ray absorptiometry (DEXA).
In n = 53 patients (29 women, 24 men) we analysed the periprosthetic BMD prospectively in certain periods. All patients had an uncomplicated postoperative course and good clinical outcome (Merle d'Aubigne score > 12). In the cross-sectional study we analysed 23 patients (13 women, 10 men). Regions of Interest (ROI) were defined according to Gruen et al. for the periprosthetic femur and to De Lee and Charnley for the periprosthetic acetabulum.
BMD significantly decreases in the periprosthetic femur as well as in the periprosthetic acetabulum during the first three months. In men BMD reaches its lowest values between six months (femur) and one year (acetabulum) after operation and then increases to 96.2% at the femur and 93.8% at the acetabulum. In women BMD decreases during the entire follow-up to 89.4% at the periprosthetic femur and 80.0% at the periprosthetic acetabulum. In the proximal zones 1 and 7 of the femur and the cranial-medial zone II of the acetabulum we observed the highest decrease of mineralisation. More than five years after implantation of the prosthesis BMD in the femur showed only little changes. On the other side BMD around the threaded acetabular cup significantly decreased to 67.4% in women and 79.1% in men.
The results reflect the different stress on the periprosthetic bone after implantation of the prosthesis and fit to earlier reported good clinical results of the CLS-stem and to increased loosening rate of threaded acetabular cups after five years. Analysing changes of mineralisation in cementless total hip arthroplasty DEXA together with the analization scheme according to Gruen at the femur and to De Lee and Charnley at the acetabulum is a useful method and has been reliable in clinical practise.
我们通过双能X线吸收法（DEXA），在一项前瞻性纵向研究中分析了人工关节周围骨密度（BMD），该研究在手术后两年内进行，同时在另一项横断面研究中分析了非骨水泥型全髋关节置换术（CLS柄，Mecron螺纹髋臼杯）植入五年多后的情况。
我们对53例患者（29名女性，24名男性）在特定时间段内前瞻性地分析了人工关节周围骨密度。所有患者术后病程顺利，临床效果良好（Merle d'Aubigne评分>12）。在横断面研究中，我们分析了23例患者（13名女性，10名男性）。根据Gruen等人的方法定义了人工关节周围股骨的感兴趣区域（ROI），并根据De Lee和Charnley的方法定义了人工关节周围髋臼的感兴趣区域。
在最初三个月内，人工关节周围股骨以及人工关节周围髋臼的骨密度显著降低。男性骨密度在术后六个月（股骨）至一年（髋臼）之间达到最低值，然后股骨处增加至96.2%，髋臼处增加至93.8%。女性骨密度在整个随访期间持续降低，人工关节周围股骨处降至89.4%，人工关节周围髋臼处降至80.0%。在股骨近端1区和7区以及髋臼的颅内侧II区，我们观察到矿化程度下降最为明显。假体植入五年多后，股骨的骨密度变化不大。另一方面，螺纹髋臼杯周围的骨密度在女性中显著降至67.4%，在男性中降至79.1%。
这些结果反映了假体植入后人工关节周围骨所承受的不同应力，与先前报道的CLS柄良好临床效果以及五年后螺纹髋臼杯松动率增加相符合。在非骨水泥型全髋关节置换术中，通过DEXA分析矿化变化，并结合根据Gruen方法对股骨和根据De Lee和Charnley方法对髋臼的分析方案，是一种有用的方法，在临床实践中是可靠的。
