股骨骨质疏松与人工髋关节置换股骨侧假体初始稳定性之相关性的实验研究  

Correlation between femoral osteoporosis and femoral prosthesis initial stability after hip replacement

作　　者：桂鉴超[1] 沈海琦[1] 王黎明[1] 黄河[1] 顾湘杰[2] 马昕[2] 陈劲松[2] 王以进[3] 

机构地区：[1]南京医科大学附属南京第一医院骨科,南京210006 [2]复旦大学华山医院骨科 [3]上海大学

出　　处：《中国骨质疏松杂志》2002年第4期303-306,共4页Chinese Journal of Osteoporosis

基　　金：江苏省卫生厅科研基金资助项目(TS2 0 0 0 0 1)

摘　　要：目的　探讨股骨骨质疏松对人工髋关节置换股骨侧假体初始稳定性的影响。方法　30具尸体股骨标本分别行非骨水泥有肩托 (NCC)、无肩托 (NCNC) ,骨水泥有肩托 (CC)、无肩托(CNC)假体置换。在生物力学试验机上行轴向载荷及扭转力矩下微动测定。结果　正常骨质量组、及轻度、中度、重度骨质疏松组之间的扭转稳定性差异显著。除了正常骨质量组与轻度骨质疏松组之间的轴向稳定性差异不显著外 ,其余组间有明显的差异。正常骨质量组 :CNC的扭转稳定性与CC无差异 ,只是轴向稳定性不如CC。就非骨水泥假体而言 ,NCC的轴向稳定性等同于CNC ,但扭转稳定性不及CNC。NCNC除了能减少假体杆端的微动外 ,其余稳定性与NCC无差异。骨质疏松组 :CC的近段轴向稳定性要优于CNC(除了重度骨质疏松组外 ) ,但远段轴向稳定性 (除了中度骨质疏松组外 )和扭转稳定性无差异。结论　股骨干骺段骨密度BMD≤ 1 0 6g cm2 应选用骨水泥假体。正常骨质量的患者采用非骨水泥假体置换 ,术后轴向稳定性很好 ,完全可以承受站立负重 ,只是应避免扭转的动作。非骨水泥假体有无肩托对初始稳定性影响不大。Objective\ To study the influence of femoral osteoporosis on the femoral prosthesis initial stability after hip replacement. Methods\ Thirty cadaver femurs were subjected to cemented collared (CC) cemented noncollared (CNC) noncemented collared (NCC) and noncemented noncollared (NCNC) prosthesis replacements, and micromotions and torsional angles (TA) were evaluated with axial loads (AL) and torsion moments (TM). Results\ There were significant differences between normal group (NG), slight osteoporosis group (SLO), moderate osteoporosis group (MOO) and severe osteoporosis group (SEO) in terms of torsional stability, and also for axial stability except between NG and SLG. In NG, the torsional stability of CNC was identical to that of CC but its axial stability was less. As for cementless prostheses, the axial stability of NCC was as good as that of CNC but its torsional stability was less. NCNC had no better stability than NCC except for having less micromotion at the stem tip.In osteoporosis groups, CC had better proximal axial stability than CNC (except for SEO), but had no difference in both disal axial stability (except for MOO) and torsional stability. Conclusion\ Cemented prosthesis is best indicated when femoral metaphyseal BMD is no more than 1\^06 g/cm\+2. Patients without osteoporosis are suited for cementless prostheses because the initial axial stability is so good that they can resume standing immediately after operations but should avoid torsional motions. Whether the cementless prosthesis has collar or not has no influence on the stem's initial stability. Cemented prosthesis with collar is especially helpful for osteoporosis patient to prevent early loosening.\;

关 键 词：股骨骨质疏松 人工髋关节置换 初始稳定性 相关性 生物力学 

分 类 号：R681[医药卫生—骨科学] R687.4[医药卫生—外科学]