骨水泥和非骨水泥固定假体周围骨溶解X线征象差异与磨损颗粒关系的初步分析

探讨不同固定方式假体周围骨溶解X线征象差异与磨损颗粒迁移特点及其易聚积部位之间的联系 ,分析磨损颗粒在假体无菌性松动中的作用。方法 :观察因无菌性松动行翻修术的 39个国产人工髋关节术前X线片 ,按部位及固定方式分组统计假体周围不同区域衬性和膨胀性骨溶解的发生率 ,并测算溶骨带宽或溶骨面积。结果 :非骨水泥固定髋臼假体周围各区 (Delee分区法 )衬性骨溶解发生率明显高于骨水泥固定组 (P <0 0 5 ) ,溶骨带宽以三区最重 (P <0 0 5 )并大于骨水泥固定组对应区 (P <0 0 5 ) ;膨胀性骨溶解以三区发生率最高 (P <0 0 5 ) ,但两种固定方式各对应区之间发生率及溶骨面积均无显著性差异 (P >0 0 5 )。柄周衬性骨溶解宽度人工股骨头组除一、四区 (Gruen分区法 )、全髋关节组除三、四区无显著性差异 (P >0 .0 5 )外 ,其它各对应区均以骨水泥固定组较重 (P <0 .0 5 ) ;膨胀性骨溶解发生率以一、七区最高 (P <0 .0 5 ) ,两种固定方式各对应区之间溶骨面积差异无显著性意义 (P >0 .0 5 )。结论 :无菌性松动假体周围骨溶解的发生部位及严重程度与磨损颗粒迁移和聚集的部位有关 ,固定方式不同骨溶解的X线表现亦有差异。阻断磨损颗粒的扩散可能是防止骨溶解发生的有效方法之一。

Differences between roentgenographic feature of osteolysis around cemented and cementless prostheses and the relations with wear particles

Objective:To study the relationship between different roentgenographic feature of osteolysis around cemented and cementless prostheses and migration pathway and collection site of wear particles. Methods:Pre revision radiographs of 39 aseptically loosened hip prostheses were observed. The incidence of liner and expansile osteolysis around components was statistically determined according to different site and fixation manner. The width or area of osteolysis waw measured.Results:The incidence of liner osteolysis at acetabulum of cementless group was significantly higher than that of cement group ( P <0.05) and the radiolucent lines were significantly wider in zone 3 (DeLee and Charnley) of cementless group ( P <0.05). The incidence of expansile osteolysis at acetabulum was highest in zone 3 ( P <0.05), but there was no significant difference in incidence and size of osteolysis between corresponding regions of the two groups ( P >0.05). The radiolucent lines at proximal femur were much wider in cement group ( P <0.05) except zone 1,4 (Gruen and Amstutz) of semi hip prostheses and zone 3,4 of total hip prostheses. The incidence of expansile osteolysis at proximal femur was highest in zone 1,7 ( P <0.05). There was no significant difference in size of osteolysis between corresponding regions of cement and cementless group ( P >0.05). Conclusion:The location and severeness of osteolysis around aseptically loosened hip prostheses have certain relation with the migration pathway and collection site of wear particles originated from articular surface. Cement and cementless prostheses have some different roentgenographic feature of osteolysis around the components. Blocking the diffusion path of wear particles could be an effective method to prevent osteolyisis.