外侧半月板切除术后膝关节周围骨密度的变化及其影响因素

外侧半月板切除术后膝关节周围骨密度的变化及其影响因素 外侧半月板切除术后膝关节周围骨密度的变化及其影响因素 作者: 刘英杰，高顺红，白俊清 【关键词】 外侧半月板切除术;骨密度;膝关节;影响因素 Change of bone mineral density around knee joint and its influential factors after lateral meniscectomy 【Abstract】 AIM: To investigate the change of bone mineral density around the knee joint and the influential factors for the change after lateral meniscectomy (LMT). METHODS: A total of 128 patients who had undergone LMT were divided into 01 year group, 24 year group, 510 year group and 1117 year group according to the time after LMT; Healthy contralateral leg was assigned to control groups respectively. According to sex , operated age and weight, they were also divided into men group, women group ; ?40 years age, 40 years age ; ?75 kg, 75 kg. The bone mineral density in the 6 regions of interest (ROI) were measured using dual energy Xray absorptiometry, and the sex, age, weight and the bone mineral density were analyzed by linear correlation. RESULTS: Bone mineral density in the 6 ROI were all decreased in 01 year group. They were decreased in R1R4 significantly to 0.93?0.30, 0.91?0.21, 1.25?0.36 and 1.30?0.51 (P0.01), respectively. In 24 year group , bone mineral density in R1 R4 were in R5 and R6 was increased. The value of changes in R1 and R3 were decreased, while it significant as 0.93?0.22 and 1.28?0.08 (P0.01) . Except that bone mineral density in R2 was decreased, the values in the other regions were increased. The bone mineral density on lateral side increased significantly to 0.95?0.12, 1.20?0.19 and 1.25?0.18 (P0.05). In 1117 year group, bone mineral density in R1 and R3 was decreased as 0.93?0.20, 1.19?0.18. There was a significant difference in parison with control groups respectively (P0.05). CONCLUSION: Adaptive bone remodeling around the knee after LMT may result from many factors. 【Keywords】 lateral meniscectomy; bone mineral density; joint knee; influential factor 【摘要】 目的: 观察外侧半月板切除术后膝关节周围骨密度的变化及其影响因素. 方法: 选择术后患者128例，根据术后时间分为: 0~1 a组, 2~4 a组,5~10 a组和11~17 a组, 对照组为对应健侧;根据性别、手术时年龄和体质量各设: 男性组，女性组;?40岁组，40岁组;?75 kg组，75 kg组;应用双能X线骨密度仪测量膝关节周围6个目的区(ROI)骨密度，并进行性别、年龄和体质量与骨密 度的线性相关. 结果: 0~1 a组6区骨密度下降, R1~R4下降显着分别为0.93?0.30, 0.91?0.21, 1.25?0.36和 1.30?0.51 (P0.01);2~4 a组R1~R4骨密度下降，而R5, R6骨密度增加，其中以R1, R3变化显着，分别为0.93?0.22和 1.28?0.08 (P0.01);术后5~10 a组除R2骨密度下降外，其余骨密度增加，以外侧ROI骨密度增加显着，分别为0.95?0.12， 1.20?0.19及 1.25?0.18 (P0.05);术后11~17 a组R1, R3骨密度下降分别为: 0.93?0.20, 1.19?0.18，与对照组比较差异有显着的统计学意义(P0.05). 结论: 外侧半月板切除术后膝关节周围发生适应性骨重构是多种因素作用的结果. 【关键词】 外侧半月板切除术;骨密度;膝关节;影响因素 0引言 半月板损伤在临床上十分常见,常用的治疗方法是施行半月板切除手术(meniscectomy, MT). 临床已有研究发现MT术后骨性关节炎的发生率明显增加;Petersen等,1,证实内侧半月板部分或全部切除后，膝关节周围骨密度发生了明显的变化. 然而，对于外侧半月板切除术(lateral meniscectomy, LMT)所引起膝关节周围骨密度的改变， 其发生可能与多种因素有关，目前其确切的发病尚不清楚. 因此，我们拟对LMT术后膝关节周围骨密度作横向时间点的研究，并进行性别、年龄和体质量等因素与LMT术后膝关节周围骨密度相关性的分析. 1对象和方法 1.1对象选择1984/2017我院、唐山市第二医院以及开滦矿务局总医院施行LMT的患者128(男64，女64)例;年龄14~68(平均42.2)岁. 所有研究对象肝肾功能正常,排除影响骨代谢的各种因素如: 长期服用激素、钙剂等药物史, 既往膝关节未作过任何手术;只 各种急慢性疾病, 接受单侧膝关节LMT,且术后无感染、出血、积液等手术并发症. 既往无感染性关节炎、关节退行性变化及骨性关节炎等病史. 按LMT术后时间进行分组: 0~1 a组，32例;2~4 a组，32例;5~10 a组，30例;11~17 a组，34例;设对应健侧为对照组. 另外，按性别、手术时年龄和体质量分为: 男性组，女性组;?40岁组，40岁组;?75 kg组，75 kg组，共6组. 1.2方法均着单衣测量体质量，再扣除单衣质量，读数精确至0.5 kg. 采用XR36型双能X线骨密度仪(Norland公司，美国)测量骨密度. 具体测量方法: 患者平卧扫描床上，脚固定使脚尖垂直向上，膝关节保持伸直位. 仪器:精密度1%，准确度1%，分辨率 1 mm×1 mm，平均扫描剂量2.4 mkev，平均扫描时间7 min，扫描范围: 上端至髌骨上2 cm，下端至腓骨小头下2 cm. 本研究采用6区法,1,: 以胫骨上端松质骨区腓骨小头水平面作为参考平面，在胫骨外、内侧分别作0.8 cm×0.8 cm的目的区(region of interest, ROI)，称为R1, R2. 以股骨下端股骨髁间切迹水平面作为参考平面，在股骨内外侧髁分别作0.8 cm×0.8 cm的ROI，称为R3, R4. 在胫骨上端密质骨区胫骨平台外、内侧软骨下分别作 1.4 cm×0.4 cm的ROI，称为R5, R6, 共扫描3次，测量不同ROI骨密度(图1).。