血清瘦素对全髋关节置换术后假体稳定性影响的临床研究  

Effects of serum leptin on the stability of prosthesis after total hip replacement

作　　者：刘加钱[1] 施明宏 黄婧雯 黄群 孙琦[1] 潘小峰[1] 邹澍[1] 吕仁发[1] LIU Jiaqian;SHI Minghong;HUANG Jingwen;HUANG Qun;SUN Qi;PAN Xiaofeng;ZOU Shu;LYU Renfa(Department of Orthopaedics, The 184th Hospital of People..s Liberation Army, Yingtan 335000, China)

机构地区：[1]解放军第184医院骨科,江西鹰潭335000

出　　处：《骨科》2017年第6期464-467,共4页ORTHOPAEDICS

摘　　要：目的探讨血清瘦素对全髋关节置换术后假体稳定性的影响。方法本研究分析2013年1月至2014年1月我院收治的全髋关节置换术病人165例资料,男103例,女62例,年龄为49~75岁,平均(64.28±6.12)岁。左髋关节置换88例,右髋关节置换77例。术前髋关节Harris功能评分(Harris评分)为27~52分,平均(42.18±4.48)分。身体质量指数为19.83~32.37 kg/m^2,平均(24.73±2.74)kg/m^2。其中,23例合并糖尿病,12例合并高血压病,28例合并高脂血症。根据术后3年内是否出现假体松动,将病人分为松动组(假体松动,11例)、稳定组(假体稳定,154例)。观察血清瘦素、假体周围骨密度、假体松动率、年龄、性别、身体质量指数、Harris评分等。比较发生与未发生假体松动的病人间术前血清瘦素、假体周围骨密度的情况,分析血清瘦素与全髋关节置换术病人临床特征,并探讨血清瘦素与假体周围骨密度的线性相关性。结果术后第3年,松动组病人ROI 1区骨密度为(0.69±0.14)g/cm^3,低于稳定组的(0.78±0.12)g/cm^3;ROI 3区骨密度为(1.46±0.22)g/cm^3,低于稳定组的(1.62±0.25)g/cm^3;ROI 6区骨密度为(1.20±0.21)g/cm^3,低于稳定组的(1.40±0.26)g/cm^3;以上几组数据比较,差异均有统计学意义(均P<0.05)。两组病人其他4个ROI区骨密度比较,差异均无统计学意义(均P>0.05)。松动组病人术前血清瘦素为(6.81±1.42)μg/L低于稳定组的(8.45±2.18)μg/L,差异有统计学意义(t=2.448,P=0.015)。术前年龄≥65岁的病人血清瘦素为(8.51±2.13)μg/L,与<65岁的(8.17±2.22)μg/L比较;男性血清瘦素为(8.34±2.17)μg/L,与女性的(8.33±2.19)μg/L比较,以上差异均无统计学意义(均P>0.05)。身体质量指数>25 kg/m^2的病人血清瘦素为(7.98±2.15)μg/L,与≤25 kg/m^2的(8.65±2.16)μg/L比较;术后Harris评分≥80分的病人血清瘦素为(8.09±1.61)μg/L,与<80分的(7.09±1.52)μg/L比较,以上差异均有统计学意义(均P<0.05)。术前血清瘦素与术�Objective To explore the effect of serum leptin on the stability of prosthesis after total hip replacement(THR).Methods165cases of THR in our hospital were prospectively collected from January2013to January2014.The correlation between the serum leptin with the periprosthetic bone mineral density,periprosthetic loosening and other postoperative clinical features was analyzed.Results Three years after THR,the bone density of ROI1(0.69±0.14vs.0.78±0.12g/cm3,P=0.019),that of ROI3(1.46±0.22vs.1.62±0.25g/cm3,P=0.041)and that of ROI6was reduced significantly(1.20±0.21vs.1.40±0.26g/cm3,P=0.014)in the patients with prosthesis loosening as compared with the patients with prosthesis in a stable condition.The preoperative level of serum leptinin the patients with prosthesis loosening was significantly lower than that in the patients with prosthesis in a stable condition(6.81±1.42vs.8.45±2.18μg/L,P=0.015).As compared with patients whose BMI≤25kg/m2,the preoperative level of serum leptinin the patients with BMI>25kg/m2was reduced significantly(7.98±2.15vs.8.65±2.16μg/L,P=0.046).As compared with the patients with Harris score<80at3rd year after THR,the level of serum leptinin the patients with Harris score≥80was increased significantly(8.62±2.17vs.7.51±1.99μg/L,P=0.004).There was a positive correlation between the preoperative serum leptin with bone density of ROI1and ROI6at3rd year after THR(r=0.167and0.212;P=0.032and0.006).Conclusion The reduction of the serum leptin is probably related to the periprosthetic bone mineral density and the periprosthetic loosening after THR.

关 键 词：瘦素 骨质疏松 骨密度 关节成形术 置换 髋 髋假体 

分 类 号：R687.4[医药卫生—骨科学]