膝骨关节炎全膝关节置换前骨质疏松的相关因素分析  

Osteoporosis-related factors in patients with knee osteoarthritis before total knee arthroplasty

作　　者：任志帅 程招军 孙和军[1] 孙振辉[1] 崔子健[1] 张黎龙[1] 林雍智 张仁赞 彭兵[1] 张学利[1] 

机构地区：[1]天津市人民医院,天津市300000 [2]南开大学医学院,天津市300017

出　　处：《中国组织工程研究》2016年第22期3212-3218,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:骨质疏松对全膝关节置换最大的危害在于围手术期及远期假体周围骨折。然而受限于骨关节炎患者通常不伴有骨质疏松的传统观念,国内临床尚未对全膝关节置换前的骨质疏松情况给予足够重视。目的:分析骨关节炎患者全膝关节置换前骨质疏松情况及其相关因素。方法:回顾性分析天津市人民医院关节外科2012年1月至2014年11月收治的膝关节骨关节炎全膝关节置换患者81例(81膝),置换前均行腰椎和髋部骨密度检查。分析置换前患者骨密度与年龄、体质量指数、膝关节活动度、膝关节畸形程度的相关性,并对置换前骨质疏松的独立危险因素进行分析。结果与结论:181例患者中骨密度正常25例(31%),骨量减低35例(43%),骨质疏松21例(26%);男性10例均无骨质疏松,女性71例中骨质疏松21例(30%),女性患者骨质疏松发生率显著高于男性(P=0.046);2患者全髋骨密度与年龄、体质量指数之间存在线性相关,相关系数r分别为-0.230,0.225;3年龄≥65岁、体质量指数≥25 kg/m2是全膝关节置换前骨质疏松的独立危险因素(P<0.05);4提示膝关节骨关节炎全膝关节置换前患者骨量减低和骨质疏松发生率较高,骨质疏松程度与年龄成负相关,与体质量指数成正相关。年龄≥65岁、体质量指数<25 kg/m2是骨质疏松的独立危险因素,此类患者全膝关节置换前需要进行骨密度检查予以明确。BACKGROUND：The greatest risk of osteoporosis in total knee arthroplasty is perioperative and long-term periprosthetic fractures.However,limited by the traditional concept of osteoarthritis patients who usually not associated with osteoporosis,domestic clinical trials have not given enough attention to the osteoporosis before total knee arthroplasty.OBJECTIVE：To analyze the osteoporosis and its relative factors in osteoarthritis patients before total knee arthroplasty.METHODS：Data of 81 cases（81 knees） of knee osteoarthritis who underwent total knee arthroplasty in the Department of Joint Surgery of Tianjin People＇s Hospital from January 2012 to November 2014 were retrospectively analyzed.They received lumbar spine and hip bone mineral density examination before surgery.The correlation of bone mineral density with age,body mass index,knee motion range,and knee deformity was analyzed before surgery.The independent risk factors for osteoporosis before replacement were analyzed.RESULTS AND CONCLUSION：（1） Of 81 patients,there were normal bone mineral density in 25 cases（31%）,osteopenia in 35 cases（43%）,and osteoporosis in 21 cases（26%）.All 10 males had no osteoporosis and 21 in 71 female cases suffered osteoporosis（30%）.The incidence of osteoporosis in females was significantly higher than in male patients（P=0.046）.（2） There was a linear correlation of bone mineral density with age and body mass index（correlation coefficient r=-0.230,0.225）.（3） The age of ≥ 65 years and body mass index ≥ 25 kg/m2 were independent risk factors of osteoporosis before replacement（P〈0.05）.（4） Patients with knee osteoarthritis had higher incidence of osteopenia and osteoporosis before total knee arthroplasty.The degree of osteoporosis was negatively correlated with age,but positively correlated with body mass index.The age of ≥ 65 years and body mass index 25 kg/m2 were independent risk factors for preoperative osteoporosis.Thus,bone mineral density examination is essential

关 键 词：关节成形术 置换 膝 骨关节炎 骨密度 骨质疏松 组织工程 骨科植入物 人工假体 全膝关节置换 膝骨关节炎 

分 类 号：R318[医药卫生—生物医学工程]