关键词 人工髋关节置换；人工假体；骨丢失；影响因素

    摘要 目的 观察人工全髋关节置换术(THA)术后假体周围骨量丢失的原因及相关影响因素,提高THA手术疗效, 有效指导临床。方法 83例THA及股骨头置换患者，年龄16~83岁，平均61.16岁。按性别、术时年龄、股骨柄假体形状、股骨柄的长度、手术入路、THA病因诊断、骨水泥固定方式、术后开始负重时间不同分组，双能X线骨密度仪(DEXA)测量THA术后股骨柄假体及髋臼假体周围的骨密度，以对侧作为对照，得出骨丢失量，并分析其影响因素。结果 性别、术时年龄、股骨柄假体形状、股骨柄的长度、手术入路、THA病因诊断、骨水泥固定方式、术后开始负重时间对术后BMD变化没有影响。结论 ①DEXA可以定量性的判定THA术后假体周围的骨量丢失，用以预测假体松动或关节不稳。②尽管THA术后假体周围BMD的改变与性别、术时年龄、股骨柄假体形状、股骨柄的长度、手术入路、THA病因诊断、是否用骨水泥固定、术后开始负重时间等无明显的相关性，但与假体手术操作技术密切相关。

    BONE LOSS OF PERIPROSTHETIC AFTER TOTAL HIP ARTHROPLASTY

    Wang Jieying,Gong Haifeng,Zhang Liu,et al.

    Department of Orthropedics, Beijing ChuiYangLiu Hospital，Beijing 100022,China

    Key words total hip arthroplasty; artificial prosthesis; bone loss; influential factor

    Abstract Objective To analyze the change of periprosthetic bone mineral density (BMD) after total hip arisplasty (THA) by dual energy arisplasty (DEXA); to study the time of osteolysis and bone reconstruction to find its influential factors; and to provide the effective data for clinical dignosis and treatment to prevent bone loss. Methods 83 patients with THA were treated in Tangshan Hospitals from 1982-2002, aged 16 to 83 years, complications at the early stage were not remarkable. All the patients were randomly divided into different groups according to bone cement, gender, length and image of femur prosthesis, operative age and incision, operative causes and the ambulation time. Periprosthetic BMD of 11 regions of interest was determined with DEXA operatively in both femor and hip cup and nonoperatively in the involved side of 83 patients, compared nonoperative side were used as controls. Results Whether bone cement was fixed or not, the BMD around hip cup decreased significantly , especially within postoperative 1 year or 7 years later.During 4-6 years after THA ,there was little change of BMD around hip cup. Whether bone cement was fixed or not, the BMD in femur showed little change,even went up after 7 years.Bone cement , gender, length and image of femur prosthesis, operative age and incision, operative causes and ambulation time didn't affect BMD around periprosthetic. Conclusion DEXA is an effective tool on diagnosing the dislocation of periprosthetic and planning clinical therapy. The BMD around hip cup decreased earlier, much more rapidly and much more seriously, especially in heavy burdon district. It begin to drop within 1 year and get heavier after 7 years, there's no change in BMD obviously. No significant differentce of BMD is observed according to bone cement, gender, length and image of femur prosthesis, operative age and incision, operative causes and ambulation time, but it is related to operative technology intimately. ......