人工股骨头置换术后骨质疏松病因分析

本文观察了1990年前施行并获2年以上随访的99例人工股骨头置换术后患者.对术后假体柄周围骨反应,尤其是股骨大粗隆处骨质疏松的原因,以及骨反应与疼痛的关系进行了分析.认为骨反应与假体在髓腔内的稳定及应力分布有关.由于Moore型人工股骨头的枘较细,有颈托,负重后应力集中在股骨矩上,导致股骨大粗隆处应力明显减弱,发生废用性骨质疏松.股骨大粗隆骨质疏松还与使用骨水泥及大粗隆处切骨过多等因素有关.分析中发现疼痛与骨萎缩发生的部位及数目呈正相关(P<0.05).认为改善假体柄的形态与表面处理.提高假体柄与骨髓腔内壁的接触面,以及提高髓腔占据率,避免应力分布不匀.可减少骨反应及疼痛的发生.

An Etiological Analysis of Osteoporosis in Postoperative Substitution by Artificial Femur

This Paper reports 1) observation of 99 cases with artificial femur substituted before 1990 and followed-up for over two years, 2)changes of postoperative peripheral prosthetic stem, especially, the cause of os-theoporosis of greater trochnanter and 3) relationship between bone changes and pains, It is believed that bone changes is related to the stability of prosthesis in marrow cavity and stress distribution. Since its thin stem of Moore Type artificial femur and its neck bracket.the stress concentrates on femur calcar when loaded,leading to obvious decrease of stress on greater trochanter and disuse osteoporosis. Osteoporosis is also associated with the use of osteo-cement and frequent osteomies of greater trochanter. It is also found in the analysis that there is positive correlation (P<0. 05) between pains and the location and number of bone atrophy. It is thought that improving shapes and surface processing of prosthetic stem, enlarging the occlusal surface of prosthetic stem and inner walls of pulp chamber ,occupying more marrow cavity and distributing stress evenly can reduce none changes and pains.