外侧半月板切除术对成人膝关节周围骨密度的影响

Effect of lateral meniscectomy on bone mineral density around the joint knee in adult

目的观察外侧半月板切除术(lateralmeniscectomy,LMT)对膝关节周围骨密度的影响。方法选择术后患者128例,根据术后时间分为:0～1年组、2～4年组、5～10年组和11～17年组,设对应健侧为对照组,应用双能X线骨密度仪分别测量膝关节周围六个感兴趣区(regionofinterest,ROI)骨密度,并拍摄术侧膝关节计算机辅助的X线照片(computedroentgenograph,CR)。结果0～1年组膝关节周围六个ROI骨密度均下降,R1～R4骨密度分别与对照组比较差异有统计学意义(P<0.01);术后2～4年组R1～R4骨密度均下降,而R5、R6骨密度有所增加,其中以R1、R3变化显著,分别与对照组比较差异有统计学意义(P<0.01);术后5～10年R2骨密度下降,但其余ROI骨密度增加,以外侧ROI骨密度增加明显,分别与对照组比较差异有统计学意义(P<0.05);术后11～17年组R1、R3骨密度下降,分别与对应健侧比较差异有统计学意义(P<0.05);CR片结果:部分正常,有的表现为骨小梁模糊、密度减低、可见局限性小片状骨质吸收区,有的表现为关节面内侧密度稍低、外侧密度增高,内髁小梁稀少、骨密度减低,股骨外髁骨质增生、轻度膝外翻,胫骨小梁减少、模糊但密度正常。结论LMT术可引起膝关节周围适应性的骨重构。

Objective To investigate the effect of lateral meniscectomy （LMT） on bone mineral density （BMD） around the knee joint. Methods Totally, 128 patients underwent LMT were selected and divided into 4 groups according to the duration after the operation：0-1 year,2-4 year,5-10 year and 11-17 year, While the healthy legs in the other side was set as control group. The BMD in the six region of interest （ROI） were measured using dual energy X-ray absorptiometry. The computed roentgenograph （CR） of menisoectomized knee in anteroposterior location were taken. Results The BMD in the six ROI were all decreased in 0-1 year group with more significant decrease in R1-R4 （ P 〈 0.01）. In the 2-4 year group,BMD in RI-R4 were decreased while increased in R5 and R6 and significant changes found in RI and R3 （P 〈 0.01 ）. Except of decreased BMD in R2, the values of all ROI were increased in the 5-10 year group. There were a significant differences as compared with control group respectively （P 〈 0.05）. In 11-17 year group, BMD in RI and R3 were decreased with significant differences as compared with control group respectively （ P 〈 0.05）. The results of CR showed that parts of meniscectomized knees were normal. While another appeared as tradecular dark and decreased mineral density. Local flake absorbed areas of bone mass were found. In another patients, mineral density on medial side of knee joint was lower lightly while it was increased on lateral side. Moreover, trabecular was sparsity and mineral density was decreased in medial condyle .The bone mass of femoral lateral condyle was hyperplasia. The meniscectomized knee was thrown into a slight ectmpion direction. Trabecular in tibia were decreased, dark but the mineral density were normal. Conclusion LMT may caused adaptive bone remodeling around the joint knee.