犬HA涂层股骨柄结合自体颗粒骨移植后假体周围骨CT值评估

CT Assessment of Periprosthetic Bone Mineral Density After Hip Hemiarthroplasty Using HA Coating Femoral Stem with Autogeneous Morselized Bone in Canines

目的:从CT值的角度分析髓腔颗粒骨植骨对犬HA涂层股骨柄置换后股骨柄周围骨密度的影响。方法:24只健康成年杂种犬随机分为颗粒骨组和非颗粒骨组,每组各12只;均行右侧人工股骨柄置换术,实验组在植入HA涂层股骨柄的同时,髓腔植入自体微小颗粒骨,对照组不植入颗粒骨。术后应用16排螺旋CT扫描仪来测定并分析假体周围的CT值,随访时间为3个月。每个股骨测量70个CT值(每个股骨按照Gruen法,分为7个区,每区取10个点)组成数据集,采集数据时应用标准的CT软件ADW4.2观察并分析结果。结果:手术方式、术后时间对假体周围ROI1和ROI7(ROI:感兴趣区)CT值的影响没有显著差异,手术方式与术后时间也不存在交互作用,p值均大于0.05;手术方式与术后时间对ROI5,ROI6区CT值的影响均有显著性(p<0.05);ROI2,ROI3,ROI4随时间推移假体周围CT值均有不同程度的降低,差异有统计学意义(P<0.05),而手术方式对此三区术后CT值变化的影响不具有统计学意义。结论:3个月内2组股骨假体周围的大部分区域骨密度均呈进行性下降趋势,颗粒骨在假体周围某些区域可缓解股骨柄移植后的骨密度降低。骨CT值可间接反映骨密度的变化,CT测量准确便捷,可提供了大量三维CT值,适于进行骨密度的研究。

Objective：Using CT values to analyze the effect of autogeneous morselized bone graft to the bone mineral density around the femoral stem after replacement operation of artificial femoral head with HA coating artificial femoral stem.Methods：24 healthy adult hybrid canines are divided equally into two groups which are particulate bone group and non-particulate bone group and undergo right side femoral head replacement operation.To the experiment group,when the HA coating femoral stem is grafted,autogeneous morselized bone is grafted together into the marrow cavity,while the control group not.After operation the periprosthetic bone CT value is measured and assessed in use of 16-slice Spiral CT,the follow up time is 3 months.70 CT values（Each femor is divided into 7 zones with gruen zoning laws,and 10 points are collected in each zone） are taken in each femor to compose the data set in use of the standard CT software＂Dicom Works＂to observe and analyze the result.Results：In three months after operation,the statistical analysis of the CT values in ROI（region of interest）1 and ROI 7 shows that periprosthetic bone mineral density in different operate methods and at different postoperative time points did not show significant difference,nor is there any interaction effect between operation method and postoperative time,p0.05.In ROI 5 and ROI 6 operation method and postoperative time have a significant effect on CT values,p0.05.CT values in ROI 2,ROI 3 and ROI 4 decrease in different degree with time,which has statistical significance.While operation methods have no significantly effect on postoperative bone mineral density change in those three zones.Conclusion：In three months＇periprosthetic bone mineral density in most region decreased progressively which can be observed in both groups.In some region,the graft of autogeneous morselized bone around the prosthesis can relieve the bone mineral density decrease after femoral stem transplantation.The bone CT value can reflect the change of bone mineral density indirectly.CT measurement is precise and convenient and can provide massive three-dimensional CT values which is suitble for research of bone mineral density.