西安地区1478例骨密度调查研究

目的 调查西安地区部分人群骨密度,为建立骨密度正常参考值数据提供资料.方法 应用双能X线骨密度仪对西安地区1478例受检对象进行骨密度检测,分析各年龄组骨密度值,以及骨量丢失率及患病率,用SPSS13.0分析软件进行统计学处理.结果 西安地区女性和男性骨密度峰值(PBM)分别出现在20～24岁和30～34岁年龄组, 随后呈下降趋势,但女性在30～34岁和50岁左右,其BMD值各形成一个波形向上小峰,男性BMD于40岁左右和60～64岁呈现相同波形.各部位BMD均下降,其中以沃氏三角降低幅度最大.同年龄段和同一测量部位的男性BMD均高于女性.女性在50岁以后、男性在55岁以后骨密度值明显降低,骨量丢失率增加,OP发生率升高.结论 骨质疏松发生率与增龄呈明显正相关, 女性在50岁以后、男性在55岁以后,OP的发生几率增大,应及早预防.     

贵阳地区1123例健康成人骨密度调查

目的了解本地区成年人群腰椎、股骨近端各部位骨密度（Bone mineral density BMD）的变化规律及骨质疏松患病率情况,为骨质疏松的诊断及预防提供科学依据。方法采用美国Lunar公司的Prodigy系列双能X线骨密度仪测量1123例成年人群腰椎、非优势（左）股骨近端各部位（股骨颈、大粗隆及Wards三角）BMD值,按5岁1个年龄组分11组对数据进行统计分析。结果贵阳地区成年女性腰椎及股骨近端骨峰含量出现在25-29岁组,成年男性腰椎及股骨近端骨峰含量出现在30-35岁组,且腰椎及股骨近端各部位BMD值均随年龄增长而下降,在50-59岁后骨量呈快速丢失现象。结论骨质疏松患病率与增龄有关,女性50岁以后、男性60岁以后患病几率增大,应及早预防。     

人工髋关节翻修病人假体周围骨密度的变化

[目的]使用双能X线骨密度仪（DEXA）测量9例人工髋关节翻修病人股骨近端假体周围骨密度,了解人工髋关节翻修病人假体周围骨丢失情况。[方法]因假体松动而接受初次人工全髋关节翻修手术病人9例,用双能X线骨密度仪（DEXA）对比测量双侧股骨近端骨密度,测量区域的划分采用Gruen七区法。术前临床评估以Harris髋关节评分（HHS）为标准。[结果]9例病人HHS评分61分,DEXA测量结果发现所有病人手术侧骨密度较非手术侧均出现明显下降,范围在8.9%～27.6%,平均15.4%,下降有统计学意义（P〈0.05）。[结论]人工髋关节置换术后早中期失败的病人,股骨近端假体周围骨丢失明显。     

青岛地区1206例骨密度调查研究

目的调查青岛地区部分人群骨密度,为骨密度正常参考值数据提供资料,为青岛乃至全国骨质疏松的预防、诊断、治疗提供科学依据。方法应用双能X线骨密度仪对青岛地区1206例受检对象进行骨密度检测,得出各年龄组骨密度值,计算骨量丢失率及患病率,用SPSS10.0分析软件进行统计学处理,进行各年龄组间差异比较。结果青岛地区男、女骨密度峰值均在25～29岁年龄组,女性50岁、男性60岁以后骨密度值明显降低,骨量丢失率增加,患病率升高。结论骨质疏松患病率与增龄呈明显正相关,女性50岁以后、男性60岁以后患病几率增大,应及早预防。     

人工踝关节置换后疗效评价

人工踝关节置换的疗效已有显著提高,作为人工关节学科中一种已有广受瞩目的发展,它的进步、术后疗效的评价无疑是人工踝关节的重要环节。本文探讨国外人工踝关节疗效评价标准的同时,提出我国的人工踝关节置换疗效评价方法。     

绝经后女性类风湿性关节炎患者腰椎和股骨近端骨密度测量

为了观察绝经后女性类风湿性关节炎（ＲＡ）患者骨矿物质密度水平的变化，采用双能Ｘ线骨密度仪（ＤＥＸＡ）测量２３例绝经后女性ＲＡ患者和年龄、性别匹配的２３例正常健康者的腰椎２～４（Ｌ２～Ｌ４）和右侧股骨近端（股骨颈、大转子和Ｗａｒｄ＇ｓ三角区）的骨密度（ＢＭＤ）。结果表明，绝经后女性ＲＡ患者Ｌ２～Ｌ４、右侧股骨近端的ＢＭＤ测量值（ｇ／ｃｍ２）明显低于年龄和性别匹配的正常健康者（Ｐ＜０．０５）。绝经后女性ＲＡ患者Ｌ２～Ｌ４骨密度的Ｚ－ｓｃｏｒｅ与糖皮质激素用药时间呈显著负相关（ｒ＝－０．５８，Ｐ＝０．００３，ｎ＝２３）。提示绝经后女性ＲＡ患者存在明显的骨质丢失。     

老年2型糖尿病患者骨密度及临床相关因素分析

目的 了解老年2型糖尿病患者骨密度的变化，初步探讨临床相关因素对骨密度变化的影响。方法 采用双能X线骨密度仪测定65例老年2型糖尿病患者及80例年龄、性别匹配的正常对照者腰椎及髋部骨密度，同时测定前者空腹血糖（FBG）、餐后2h血糖（PBG）、空腹C肽、餐后2hC肽、果糖胺（FA）、糖化血红蛋白（HBAle）、胆固醇（chol）、甘油三酯（TG）。结果 65例糖尿病患者各部位骨密度值均低于正常对照者，但仅腰椎降低有统计学意义（P〈0．05）；糖尿病组30例（45％）合并骨质疏松（OP）。OP与非0P组病程有显著性差异（P〈0．05）。结论 2型糖尿病会导致骨矿密度减低，并与糖尿病病程密切相关。     

人工踝关节置换的X线评价

[目的]研究人工踝关节置换前后的X线片评价。[方法]提出术前和术后的踝关节正侧位片的X线片评价要点进行分析,根据X线影像确定术前的切骨部位、植骨和固定方法,明确了假体的正确位置和位置异常可能导致的并发症。如踝关节不稳定、半脱位、胫骨基板倾斜、边缘载荷和影像学松动等。[结果]43例随访2年~8年4个月,平均5年5个月。踝关节功能采用Kofoed评价标准和作者评价方法进行分析,优(85~100)32例,良(75~84)9例,差(60~74)2例,无失败(<60)。踝关节功能状况:足背伸6°~16°,跖屈8°~28°,足背伸和跖屈的活动范围14°~38°,平均21.4°。并发症有切口缘皮肤坏死3踝,术中内外踝骨折1踝。无足内翻、足外翻和假体影像学松动病例。[结论]采用正确的X线评价,是提高人工踝关节置换质量,防范和及早发现并发症的重要措施。     

人工踝关节置换:43例5年5个月随访结果

目的研究人工踝关节置换治疗踝关节病损的疗效。方法1997年10月～2006年3月人工踝关节置换治疗43例踝关节病损，包括踝关节骨关节炎22例，创伤性踝关节炎21例。其中2例为距骨局限性坏死，1例为胫骨骨折并骨筋膜室综合征行广泛切除踝关节融合术后。结果43例随访2年。8年4个月，平均5年5个月。踝关节功能采用Kofoed评价标准和作者自定评价方法进行分析：优（85～100分）32例，良（75～84分）9例，差（60～74分）2例，无失败（〈60分）患者，优良率为95．3％。踝关节功能情况：足背伸6°～16°，跖屈8°～28°；足背伸和跖屈的活动范围14°～38°，平均21．4°。3例出现切口缘皮肤坏死，术中内外踝骨折1例。无足内翻、足外翻和假体影像学松动患者。结论人工踝关节置换是改善踝关节功能的良好方法。     

青岛市4434例正常人群骨密度测定分析

目的了解青岛市部分正常人群骨密度(BMD)变化的规律,为本地的骨质疏松症(OP)的诊断、预防、治疗提供科学依据。方法应用双能X线骨密度仪,测定青岛市20～79岁健康体检人群中4434人的腰椎(L2-4)、股骨上端(Neck、Ward、Troch)的骨密度,按年龄段分组,5岁为1年龄组,将其分为12组。计算骨量丢失率及患病率,用SPSS13.0软件进行统计学处理,比较各年龄组之间的差异。结果青岛市男女性骨峰值均见于25～29岁年龄组,以后随着年龄增长,骨密度逐渐降低。女性45岁、男性65岁以后骨密度值下降明显,骨量丢失率增加。结论 40岁以后应检测骨密度的变化,监测部位以股骨上端Ward最敏感;OP的防治重点在女性,尤其是绝经期妇女。老年男性,尤其是60岁以上的男性,也不容忽视。     

股骨假体周围骨密度定量测定

目的 通过双能X线骨密度仪测定不同情况下股骨假体周围的骨密度变化情况,了解骨丢失与股骨假体松动的关系。方法 分为骨水泥固定的股骨假体组、非骨水泥固定的股骨假体组、股骨假体松动组共3个组,采用LUNAR DPXL-L型双能X线骨密度仅(Lunar Corp Wisconsin,USA)及Orthopaedies软件,分析时用Gruen’s 7区法。结果 骨水泥固定的股骨假体组骨丢失为15．1%～29．3%,非骨水泥固定的股骨假体组骨丢失为13．2％～27．9%,股骨假体松动组骨丢失为25．4％～43．4%,3组均是股骨近端骨丢失明显．骨丢失主要发生在术后8年以内。结论 骨水泥固定的股骨假体和非骨水泥固定的股骨假体周周骨密度降低一样,假体松动者假体周围骨丢失明显增加。股骨近端2个以上区域骨丢失大于35％或术后8年以后突然出现明显的骨丢失,考虑有股骨假体松动存在的可能性。     

Distal femoral bone mineral density after total knee arthroplasty: a comparison with general bone mineral density

The bone mineral density (BMD) of the distal femur may decrease after cemented total knee arthroplasty (TKA) as a result of the stress shielding effect of the femoral component. The purpose of the study was to determine the changes in BMD of the distal femur compared with those of the femoral necks and the lumbar spine after cemented TKA. BMD of two regions of interest in the distal femur, both femoral necks and the lumbar spine was measured with dual-energy X-ray absorptiometry in 10 patients (age range 41–80 years, mean 62 years) with 12 TKAs preoperatively and during follow-up for 1 year after surgery. The hip and spine measurements were performed for comparison to assess if general changes in BMD occurred after TKA. The median decrease in BMD in the region behind the anterior flange of the femoral component was 22% (95% CI: 12%–33%), while the average decrease in the region just above the femoral component was 8% (95% CI: 2%–13%). The difference in change of BMD between both regions before and 1 year after TKA was significant (p = 0.03).We found less than 1% difference in BMD of both femoral necks and the lumbar spine on average between the preoperative and 1 year follow-up measurements (not significant). A significant periprosthetic distal femoral bone resorption occurred after TKA. BMD of the femoral necks and lumbar spine did not differ 1 year after TKA. Received: 21 March 2000     

Increased bone mineral density adjacent to hydroxy-apatite-coated ankle arthroplasty

We measured bone mineral density (BMD) in patients treated with a unilateral hydroxy-apatite-coated ankle arthroplasty. The study comprised 11 consecutive patients measured preoperatively and postoperatively after 3, 6, and 12 months (group I) and 17 patients measured once at 12 to 82 months follow-up (group II). BMD was measured in the distal tibia adjacent to the prosthesis and in the calcaneus. BMD of the calcaneus was measured bilaterally as an indicator of changes in foot load. In group I BMD was significantly increased in the distal tibia after 6 and 12 months compared to preoperative values. In group II BMD of the distal tibia was significantly higher compared to the non-operated side. No radiolucencies were detected during follow-up in any case. The increase in BMD and the radiographic findings after uncemented ankle arthroplasty indicates that it is being loaded by the prosthesis. This may indicate a well fixed prosthesis.     

Changes of femoral periprosthetic bone mineral density 6 years after treatment with alendronate following total hip arthroplasty

Earlier osteodensitometric results of femoral periprosthetic bone showed that postoperative antiresorptive treatment with alendronate following total hip arthroplasty (THA) reduces the periprosthetic bone loss that commonly occurs in the first months after surgery. However, whether alendronate can prevent periprosthetic bone loss over the long term, or if bone loss occurs after discontinuing alendronate is unknown. Femoral periprosthetic bone mineral density (BMD) was assessed in 49 patients 6 years after cementless total hip arthroplasty using dual energy X‐ray absorptiometry. Twenty‐nine patients were treated postoperatively with alendronate and 20 control patients received no treatment. All patients were followed up at 12 months after surgery in a prospective randomized study. The bone mineral density was evaluated in 7 regions of interest according to the Gruen protocol. Six years after total hip arthroplasty, no significant changes were detected in femoral periprosthetic BMD when compared with results at 1 year, and the bone loss in patients with postoperative alendronate treatment was still significantly less than those without treatment. These results suggest that the prevention of femoral periprosthetic bone loss following THA achieved by postoperative antiresorptive treatment with alendronate is of long‐standing effect, and further bone loss does not occur after the first postoperative year. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:183–188, 2009     

Periprosthetic bone mineral density of the distal femur after total knee arthroplasty

Summary Evaluation of the bone mineral density (BMD) was performed in the distal femur around the femoral component of a total knee prosthesis. A total of 48 females were enrolled for this study, including 14 with osteoarthritis of one knee undergoing total knee arthroplasty (TKA) with an Osteonics prosthesis, 14 with osteoarthritis of one knee undergoing TKA with a Whiteside prosthesis, and 20 age-matched normal controls. The BMDs of both knees were measured before operation, and then at 3, 6 and 12 months after operation. The preliminary results demonstrate a significant progressive decrease of BMD in the distal femur of the operated knees after TKA, whereas the BMD of the non-operated knees remains stable. The ratio of BMD between the operated femur and the non-operated femur began to decrease 6 months after operation, and was most obvious at the end of the first year (ranging from 7% to 27%). Further investigation is essential to determine the clinical significance of this loss of periprosthetic bone.

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Résumé L'étude de la densité minérale osseuse (DMO) du fémur distal porteur d'une prothèse totale a été réalisée. Quarante-huit femmes ont fait l'objet de cette étude. 14 d'entre-elles présentaient une gonarthrose unilatérale et ont eu une arthroplastie totale avec une prothèse Osteonics; 14 autres, toujours avec une gonarthrose unilatérale ont eu une arthroplastie totale avec une prothèse Whiteside; enfin, 20 patientes, de même tranche d'âges sans arthrose du genou ont servi de groupe témoin. La densité minérale des deux genoux fut mesurée avant l'opération, puis à 3, 6 et 12 mois après intervention. Les résultats préliminaires montrent une diminution progressive et significative de la densité minérale dans le fémur distal des genoux opérés par arthroplastie totale. La densité des genoux non opérés reste stable. Le rapport des densités entre fémur opéré et fémur non opéré commence à décroitre 6 mois après l'opération et est le plus marqué à la fin de la première année (de 7 à 27%). D'autres investigations sont nécessaires pour évaluer la signification clinique de la diminution de densité de l'os périprothétique.

     

Changes in bone mineral density of the proximal femur after total knee arthroplasty

This study investigates the relationship between total knee arthroplasty (TKA) and bone mineral density (BMD) in the same and opposite hips. The study prospectively evaluated 24 consecutive patients undergoing TKA (31 knees, 47 hips). The mean follow-up was 48 months. The mean age at latest follow-up was 69 years, and all patients had the preoperative diagnosis of osteoarthritis. BMD of the hip was measured by dual-energy x-ray absorptiometry. Despite a predicted age-related loss of 4% during 2 years, 45% of the hips on the operative side and 59% of the hips on the nonoperative side had BMD higher than preoperative levels. Of hips, 81% on the operative side and 82% on the nonoperative side had BMD that was within the expected 4% age-related loss. Assuming that higher hip BMD may be protective against later hip fractures, the results infer that, by increasing hip BMD, TKA may be protective against later hip fractures. The increase with TKA in patient mobility and the increased hip loading may be a mechanism whereby the hip BMD increases.     

Peri-prosthetic bone mineral density after total knee arthroplasty. Cemented versus cementless fixation

We compared peri-prosthetic bone mineral density between identical cemented and cementless LCS rotating platform total knee arthroplasties. Two matched cohorts had dual energy x-ray absorptiometry scans two years post-operatively using a modified validated densitometric analysis protocol, to assess peri-prosthetic bone mineral density. The knee that was not operated on was also scanned to enable the calculation of a relative bone mineral density difference. Oxford Knee and American Knee Society scores were comparable in the two cohorts. Statistical analysis revealed no significant difference in absolute, or relative peri-prosthetic bone mineral density with respect to the method of fixation. However, the femoral peri-prosthetic bone mineral density and relative bone mineral density difference were significantly decreased, irrespective of the method of fixation, particularly in the anterior distal portion of the femur, with a mean reduction in relative bone mineral density difference of 27%. There was no difference in clinical outcome between the cemented and cementless LCS total knee arthroplasty. However, both produce stress-shielding around the femoral implants. This leads us to question the use of more expensive cementless total knee components.     

Measuring bone mineral density of the pelvis and proximal femur after total hip arthroplasty

We aimed to evaluate the precision and longitudinal sensitivity of measurement of bone mineral density (BMD) in the pelvis and to determine the effect of bone cement on the measurement of BMD in femoral regions of interest (ROI) after total hip arthroplasty (THA). A series of 29 patients had duplicate dual-energy x-ray absorptiometry (DXA) scans of the hip within 13 months of THA. Pelvic analyses using 3- and 4-ROI models gave a coefficient of variation (CV) of 2.5% to 3.6% and of 2.5% to 4.8%, respectively. Repeat scans in 17 subjects one year later showed a significant change in BMD in three regions using the 4-ROI model, compared with change in only one region with the 3-ROI model (p < 0.05). Manual exclusion of cement from femoral ROIs increased the net CV from 1.6% to 3.6% (p = 0.001), and decreased the measured BMD by 20% (t = 12.1, p < 0.001). Studies of two cement phantoms in vitro showed a small downward drift in bone cement BMD giving a measurement error of less than 0.03 g/cm2/year associated with inclusion of cement in femoral ROIs. Changes in pelvic periprosthetic BMD are best detected using a 4-ROI model. Analysis of femoral ROI is more precise without exclusion of cement although an awareness of its effect on the measurement of the BMD is needed.     

Changes of bone mineral density after cementless total hip arthroplasty with two different stems

Cementless total hip arthroplasty has achieved reliable long-term results since porous coatings were developed, but postoperative changes around the stem remain poorly documented. In this study, changes of the bone mineral density (BMD) were compared between two types of cementless stem. In group B (28 patients with 31 hips), a straight tapered stem with porous plasma spray coating on the proximal 1/4 was used, while group S (24 patients with 26 hips) was given a fluted, tri-slot stem with porous hydroxyapatite coating on the proximal 1/3. In group B, there was an early decrease of BMD, which recovered after 12 months, indicating that stress shielding was minimal. In group S, however, BMD continued to decrease without recovery. The stem shape and radiological findings suggested that the cause of stress shielding in group S was distal fixation.

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Résumé Les prothèses totales de hanche sans ciment ont de bons résultats à long terme, notamment depuis qu’ont été développées les techniques de revêtement poreux, mais les modifications post opératoires autour de la pièce fémorale, ont été jusqu’à présent peu documentées. Dans cette étude, nous avons souhaité étudier les modifications de la densité osseuse (BMD) en comparant deux types de prothèses sans ciment. Dans le groupe B (28 patients, 31 hanches) une pièce fémorale droite avec un plasma spray proximal pour le groupe S (24 patients, 26 hanches) la pièces fémorale a été recouverte d’hydroxyapatite sur le tiers proximal. Les patients du groupe B ont présenté une diminution précoce de la BMD indiquant un stress shielding minime et dans le groupe S, la BMD diminue sans récupération alors que cette BMB réaugmente dans le groupe B. Ceci nous indique que la cause du stress shielding dans le groupe S est secondaire à la fixation distale.