Long Term Bone Remodeling Around the Charnley Femoral Prostheses
Long Term Bone Remodeling Around the Charnley Femoral Prostheses
复制标题
查恩利股骨假体周围的长期骨重塑
DOI：
10.1097/00003086-199605000-00019
复制
发表时间：
1996
影响因子：
4.2
通讯作者：
K. Terayama
中科院分区：
文献类型：
--
作者：
Seneki Kobayashi*;N. Eftekhar;K. Terayama
对326例Charnley型人工股骨头置换术后10 ~ 20年（平均13.3年）的股骨重建进行了随访研究。骨重建的放射学状态进行了目视评估和测量与数字化仪。从近端开始，然后向远端进展的脱矿作用导致皮质变薄，这与髓腔变宽相关，而与骨膜宽度的变化无关，发生在股骨颈内侧、股骨柄近端一半周围和远端一半周围的脱矿作用分别为87%、33%和10%。股骨柄远端周围的皮质变薄总是伴随着近端变薄，广泛的皮质变薄（近端和远端）与较低的临床评分和股骨假体的放射学松动相关。髓腔扩张指数较低、髓腔宽度较大和患者年龄≥ 60岁是广泛皮质变薄的危险因素。加速聚乙烯磨损与内侧股骨颈的吸收有关，但与皮质变薄或放射学松动无关。皮质增厚仅发生在29%的股骨柄远端半部分周围。这些发现为骨水泥型股骨假体的性能奠定了基础，并允许在评价其他股骨假体时比较骨重建。
Femoral bone remodeling after total hip replacement was studied by following patients who received 326 Charnley femoral prostheses for 10 to 20 years (mean, 13.3 years). The radiographic state of bone remodeling was visually assessed and measured with a digitizer. Demineralization that started proximally and then progressed distally caused cortical thinning, which correlated with widening of the intramedullary canal, not with changes that developed in the periosteal width, and occurred in the medial femoral neck, around the proximal half of the stem, and around the distal half in 87%, 33%, and 10%, respectively. Cortical thinning around the distal half of the stem was always accompanied by proximal thinning, and extensive cortical thinning (both proximal and distal) correlated with both lower clinical scores and radiologic loosening of the femoral prosthesis. A low canal flare index of Noble, a large canal width, and a patient age of 60 years or more were risk factors for extensive cortical thinning. Accelerated polyethylene wear was related to resorption of the medial femoral neck but not to cortical thinning or radiological loosening. Cortical thickening occurred only around the distal half of the stem in 29%. These findings establish a basis for the performance of cemented femoral prostheses, and allow comparison of bone remodeling when evaluating other femoral prostheses.