全髋关节置换术假体周围骨溶解的临床分析

Osteolysis of femoral periprostheses after total hip arthroplasty

目的 分析股骨假体周围骨溶解的发生情况、程度和方式 ,了解骨溶解与假体松动的关系。方法 根据 Gruen′s分区法 ,在标准正位 X光片上对 1980至 1996年间进行连续 X线随防的全髋关节置换术病人共 112例进行分析 ,其中骨水泥固定 84例 ,非骨水泥固定 2 8例 ,平均随访时间为 83月。结果 骨水泥固定和非骨水泥固定的假体周围骨溶解的总发生率分别为 58.3%和 2 5.0 % ,假体周围骨溶解进行性发展的发生率分别为 86%和 77% ,骨水泥固定溶骨开始发生的平均时间为 35月 ,而非骨水泥固定溶骨开始发生的平均时间为 4 1月 ,不论是骨水泥固定还是非骨水泥固定 ,溶骨发生率最高的部位均为股骨近端。结论 人工全髋关节术后股骨假体周围的溶骨发生率较高 ,溶骨一旦发生 ,便呈进行性发展 ,但因溶骨而发生假体松动需要一定的时间 ,保证股骨假体近端的良好固定和减少股骨近端的骨量丢失是防止假体周围骨溶解的重要方法之一。

Objective\ To study the osteolysis of the femoral periprostheses after total hip arthroplasty, and determine the relation between osteolysis and loosening of femoral stem. Methods\ From 1980 to 1996, AP radiographic plain films of 112 cases were analyzed.There were 84 cemented stems and 28 uncemented stems.Evaluation was carried out by Gruen′s method. Results \ The incidences of osteolysis of femoral periprostheses were 58 3% and 24 0% for cemented and uncemented stem,respectively.The incidences of progressive osteolysis were 86% and 77%,respectively.The average time periods before the occurrence of osteolysis were 35 and 41 months,respectively.The highest incidence of osteolysis was seen in proximal femur.Conclusion\ There is a high incidence of osteolysis after total hip arthroplasty.The osteolysis is progressive.It takes a longer time for osteolysis to cause the loosening of femoral stems.Good fixation between stem and femur and prevention of bone loss of proximal femur are important for prevention of osteolysis.