全髋关节置换术后病人假体松动机制的分析

Analysis of Loosening Mechanism in 43 Patients with Prosthetic Loosening

目的 :根据松动假体周围骨溶解情况分析各种机制在假体松动过程中的作用。方法 :自 1991年 8月～ 2 0 0 1年十一年期间我院行全髋关节置换术 132例病人 ,共计 137髋。失访 31例 ,2例高龄病人死于与手术无关内科疾病。剩余 99例病人 (10 2髋 )年龄范围 :35～ 78岁 ,平均年龄 6 1.5岁。平均随访时间 6 .9年。其中 4 3髋出现假体松动 ,1髋假体松动由感染引起 ,余下 4 2髋为无菌型松动 ,并伴不同程度骨溶解。将假体周围骨溶解根据形态分为衬性骨溶解和扩张性骨溶解。按 Delee & Charnley髋臼分区和 Gruen近端股骨分区标准进行假体周围骨溶解发生率的影像分析。结果 :髋臼侧扩张性骨溶解 区的发生率最高 ,为 6 9% ,骨水泥固定组与非骨水泥固定组在扩张性骨溶解发生率有显著差异 (P<0 .0 5 ) ,非骨水泥固定组各区发生率较高 ;分别为 6 8%、79% ,骨水泥固定组与非骨水泥固定组在溶骨发生率无显著差异 (P>0 .0 5 )。衬性骨溶解髋臼侧发生率 区最高 ,股骨柄侧衬性骨溶解发生率由高至低为 区、 区、 区、 区 ,两种固定形式假体周围衬性骨溶解的发生率无显著差异 (P>0 .0 5 )。结论 :磨屑诱导的炎症性骨溶解在假体松动过程中起主导作用 。

Objective:To analyze the function of seviral mechanisms in the process of prosthetic loosening according to the periprosthetic osteolysis.Methods Between August 1991 and April 2001,137 total hip replacements were performed in 132 patients.Thirty-one patients have been lost to follow-up and two great-aged patients died from unrelated diseases.In the rest,the average age of the patients at the time of the operation was 61.5 years(range,thirty-five to seventy-eight years).Follow-up ranges from twelve months to eleven years with a mean of 6.9 years.Prosthetic loosening occurred in 43 hips accompanied by osteolysis,among which one was caused by infection.Periprosthetic osteolysis is classified into liner oseolysis and expansile osteolysis and the radiographic evaluation is performed by dividing the acetabulum into three zones as Delee & charnley′s and dividing the proximal femur into seven zones as Gruen et al.Results The rate of expansile osteolysis is 69% in the acetabular Ⅲ zone and the highest in three zones and 68%,79% in the femoral Ⅰ,Ⅶ zones and higher than other zones.Between biology-fixed group and cement-fixed group,there is significant difference in the incidence of the expansile osteolysis only in acetabula( P < 0.05 ).The rate of the liner osteolysis is higher in acetabular I zone and in femoral Ⅱ,Ⅵ,Ⅴ,Ⅶ zones and there is not significant difference between two fix-type groups.Conclusion The inflammatory osteolysis induced by wear debris play a chief fole in the process of prosthetic loosening,but in the proximal femur,mechanical factor as stress shielding and earlier micromotion is the promise of debris-induced osteolysis.