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背景:骨质疏松对全膝关节置换最大的危害在于围手术期及远期假体周围骨折。然而受限于骨关节炎患者通常不伴有骨质疏松的传统观念,国内临床尚未对全膝关节置换前的骨质疏松情况给予足够重视。目的:分析骨关节炎患者全膝关节置换前骨质疏松情况及其相关因素。方法:回顾性分析天津市人民医院关节外科2012年1月至2014年11月收治的膝关节骨关节炎全膝关节置换患者81例(81膝),置换前均行腰椎和髋部骨密度检查。分析置换前患者骨密度与年龄、体质量指数、膝关节活动度、膝关节畸形程度的相关性,并对置换前骨质疏松的独立危险因素进行分析。结果与结论:181例患者中骨密度正常25例(31%),骨量减低35例(43%),骨质疏松21例(26%);男性10例均无骨质疏松,女性71例中骨质疏松21例(30%),女性患者骨质疏松发生率显著高于男性(P=0.046);2患者全髋骨密度与年龄、体质量指数之间存在线性相关,相关系数r分别为-0.230,0.225;3年龄≥65岁、体质量指数≥25 kg/m2是全膝关节置换前骨质疏松的独立危险因素(P<0.05);4提示膝关节骨关节炎全膝关节置换前患者骨量减低和骨质疏松发生率较高,骨质疏松程度与年龄成负相关,与体质量指数成正相关。年龄≥65岁、体质量指数<25 kg/m2是骨质疏松的独立危险因素,此类患者全膝关节置换前需要进行骨密度检查予以明确。
Background: The greatest risk of osteoporosis in total knee arthroplasty is the perioperative and long-term periprosthetic fractures. However, limited to osteoarthritis patients are usually not associated with the traditional concept of osteoporosis, the domestic clinical pre-total knee arthroplasty has not given enough attention to the situation. Objective: To analyze osteoporosis and its related factors before total knee arthroplasty in patients with osteoarthritis. Methods: A retrospective analysis of 81 patients (81 knees) with total knee arthroplasty of knee osteoarthritis admitted from January 2012 to November 2014 in Tianjin People’s Hospital, who underwent lumbar and hip biopsy before replacement . The correlations between BMD and age, body mass index, knee mobility, and knee deformity were analyzed before replacement and the independent risk factors for osteoporosis before replacement were analyzed. RESULTS AND CONCLUSION: Bone mineral density was normal in 25 cases (31%), osteopenia in 35 cases (43%) and osteoporosis in 21 cases (26%). There were no osteoporosis in 10 males and 71 females Osteoporosis in 21 cases (30%). The incidence of osteoporosis in female patients was significantly higher than that in males (P = 0.046). There was a linear correlation between total hip BMD and age and body mass index (P <0.05) .4 The results suggest that total knee arthroplasty of knee joint replacement (P <0.05); 3, age ≥65 years, body mass index ≥25 kg / m2 is an independent risk factor for osteoporosis before total knee arthroplasty The former patients had a higher incidence of osteopenia and osteoporosis. The degree of osteoporosis was negatively correlated with age and positively correlated with body mass index. Age ≥ 65 years old, body mass index <25 kg / m2 is an independent risk factor for osteoporosis, such patients need total bone replacement before knee replacement to be clear.