骨关节炎患者全膝关节置换前骨质疏松相关因素的分析
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摘要
为探讨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,本研究选取2014年3月至2016年6月本院收治的90例膝骨关节炎患者进行骨密度测定。根据骨密度结果将患者分为骨质疏松组和非骨质疏松组,记录两组患者的年龄、性别、BMI、伴发疾病及t值和Z值,并分析骨密度与观察指标的相关性。研究显示,在全膝关节置换前的膝骨关节炎患者中,女性患者的骨质疏松发生率显著高于男性患者(p<0.05);年龄和肥胖是髋骨密度独立的危险因素,髋骨密度与BMI呈正相关关系、与年龄呈负相关关系。因此,对于年龄≥65岁、BMI<25 kg/m~2的患者,尤其是女性患者,全膝关节置换前要进行必要的骨密度检测,以掌握其骨质疏松程度。
To investigate the osteoporosis and related factors in patients with osteoarthritis before total knee arthroplasty, A total of 90 patients with knee osteoarthritis admitted to our hospital from March 2014 to June 2016 were selected for bone mineral density determination. According to the bone mineral density results, the patients were divided into osteoporosis group and non-osteoporosis group. The age, gender, BMI, associated disease, t and Z values of the two groups were recorded, and the correlation between bone mineral density and observation index was analyzed. Studies had shown that in patients with knee osteoarthritis before total knee arthroplasty, the incidence of osteoporosis in women is significantly higher than in male patients(p<0.05); age and obesity were independent risk factors for hip bone density, hip bone density was positively correlated with BMI and negatively correlated with age. Therefore, for patients whose age ≥65 and BMI <25 kg/m~2, especially female patients, the nebone density should be tested for the degree of osteoporosis before total knee arthroplasty.
To investigate the osteoporosis and related factors in patients with osteoarthritis before total knee arthroplasty, A total of 90 patients with knee osteoarthritis admitted to our hospital from March 2014 to June 2016 were selected for bone mineral density determination. According to the bone mineral density results, the patients were divided into osteoporosis group and non-osteoporosis group. The age, gender, BMI, associated disease, t and Z values of the two groups were recorded, and the correlation between bone mineral density and observation index was analyzed. Studies had shown that in patients with knee osteoarthritis before total knee arthroplasty, the incidence of osteoporosis in women is significantly higher than in male patients(p<0.05); age and obesity were independent risk factors for hip bone density, hip bone density was positively correlated with BMI and negatively correlated with age. Therefore, for patients whose age ≥65 and BMI <25 kg/m~2, especially female patients, the nebone density should be tested for the degree of osteoporosis before total knee arthroplasty.
引文
Bai Z.X.,Chen L.B.,Cheng X.S.,Gao Y.L.,Li G.W.,Sun X.Z.,and Wang H.J.,2015,Total knee arthroplasty for knee varus deformity:follow-up evaluation of femorotibial angle and range of motion,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(9):1313-1320(白忠旭,陈林斌,程新胜,高宇亮,李广伟,孙晓智,王红军,2015,全膝关节置换修复膝内翻畸形:胫股角及膝关节活动度随访评价,中国组织工程研究,19(9):1313-1320)
Chen J.Y.,Cao X.W.,Guo D.,Huang W.K.,Liu J.,Ma Z.W.,and Pan J.K.,2015,Study on the correlation of micro perfusion,vascular invasion and cartilage degeneration of knee osteoarthritis,Shiyong Yixue Zazhi(The Journal of Practical Medicine),31(18):3063-3066(陈嘉怡,曹学伟,郭达,黄伟康,刘军,马振蔚,潘建科,2015,膝骨关节炎软骨下骨微灌注、血管侵入及软骨退变相关研究,实用医学杂志,31(18):3063-3066)
Chen X.Q.,Hu W.Y.,Lu B.,Li S.W.,Wang J.H.,and Zhang J.,2015,Total knee arthroplasty for terminal knee disease:short-term follow-up,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(26):4132-4138(陈小强,胡旺阳,陆斌,李苏皖,王金华,张健,2015,人工全膝关节置换修复晚期膝关节病变的短期随访,中国组织工程研究,19(26):4132-4138)
Chen Z.W.,Dai Z.,Liao Y.,and Tang Z.W.,2014,Study of the relationship between bone mineral density of the proximal femur and osteoporotic fractures in postmenopausal women,Zhongguo Guzhi Shusong Zazhi(Chinese Journal of Osteoporosi),20(12):1447-1449(陈志伟,戴祝,廖瑛,唐正午,2014,绝经后女性股骨近端骨密度与骨质疏松性骨折相关性研究,中国骨质疏松杂志,20(12):1447-1449)
Fu L.M.,Jiang G.W.,Ma Z.J.,Zhang S.H.,2015,Evaluation and influencing factors of knee function in aged patients withosteoarthritis before and after total knee arthroplasty,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(4):499-503(付立明,姜国旺,马兆吉,张生海,2015,全膝关节置换前后老年骨关节炎患者关节功能评估及影响因素,中国组织工程研究,19(4):499-503)
Gao W.L.,Ma Z.X.,Xu P.F.,and Yin Z.S.,2015,Epidemiology of total knee arthroplasta retrospec tive analysis among 1146cases in Hefei City from 2008 to 2013,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(4):504-509(高维陆,马志翔,许鹏飞,尹宗生,2015,全膝关节置换流行病学分析:2008至2013年合肥市1 146例回顾,中国组织工程研究,19(4):504-509)
Hao J.,and Quan Z.X.,2016,Imaging diagnosis of osteoporotic vertebral compression fractures,Zhonghua Chuangshang Zazhi(Chinese Journal of Traumatology),32(9):769-771(郝杰,权正学,2016,骨质疏松性椎体压缩骨折的影像学诊断,中华创伤杂志,32(9):769-771)
Ho L.B.,Kim T.H.,Chong H.S.,Lee S.H.,Park J.O.,Kim H.S.,Shim D.W.,Lee H.M.,and Moon S.H.,2015,Prognostic factors for surgical outcomes including preoperative total knee replacement and knee osteoarthritis status in female patients with lumbar spinal stenosis,J.Spinal Disord.Tech.,28(2):47-52
Jauregui J.J.,Cherian J.J.,Pierce T.P.,Beaver W.B.,Issa K.,and Mont M.A.,2015,Long-term survivorship and clinical outcomes following total knee arthroplasty,Journal of Arthroplasty,30(12):2164-2166
Kagotani R.,Yoshida M.,Muraki S.,Oka H.,Hashizume H.,Yamada H.,Enyo Y.,Nagata K.,Ishimoto Y.,Teraguchi M.,Tanaka S.,Nakamura K.,Kawaguchi H.,Akune T.,and Yoshimura N.,2015,Prevalence of diffuse idiopathic skeletal hyperostosis(DISH)of the whole spine and its association with lumbar spondylosis and knee osteoarthritis:the ROADstudy,J.Bone Miner Metab.,33(2):221-229
Li C.,Lv W.H.,Liu X.G.,Liu X.G.,Wang T.T.,Wang Z.F.,Xing Y.R.,Zheng L.L.,and Zhang L.X.,2015,The study of prevalence of osteoporosis in 1 088 medical workers,Zhongguo Guzhi Shusong Zazhi(Chinese Journal of Osteoporosis),21(10):1217-1220(李冲,吕伟华,刘晓钢,王亭亭,王志芳,邢玉荣,郑丽丽,张丽侠,2015,1 088例医务人员骨质疏松的流行病学研究,中国骨质疏松杂志,21(10):1217-1220)
Li n H.,and Xu Y.J.,2015,Perioperative intervention of osteoporotic fracture,Zhonghua Guke Zazhi(Chinese Journal of Orthopaedics),35(10):1022-1026(林华,徐又佳,2015,骨质疏松性骨折围手术期干预,中华骨科杂志,35(10):1022-1026)
Liu J.Q.,and Niu W.,2008,Progress in research on causes and pathogenic mechanism of arthritis in knee-pan,Changchun Zhongyiyao Daxue Xuebao(Journal of Changchun University of Traditional Chinese Medicine),24(3):344-345(刘加钱,牛维,2008,膝骨关节炎病因及发病机制研究进展,长春中医药大学学报,24(3):344-345)
Lv S.M.,and Zhang R.L.,2016,Epidemiological study of knee osteoarthritis in middle aged and elderly,Zhongguo Laonianxue Zazhi(Chinese Journal of Gerontology),36(16):4133-4135(吕苏梅,张瑞丽,2016,中老年膝骨关节炎的流行病学研究进展,中国老年学杂志,36(16):4133-4135)
Miller R.E.,Tran P.B.,Obeidat A.M.,Raghu P.,Ishihara S.,Miller R.J.,and Malfait A.M.,2015,The role of peripheral nociceptive neurons in the pathophysiology of osteoarthritis pain,Curr.Osteoporos.Rep.,13(5):318-326
Multanen J.,Heinonen A.,Hkkinen A.,Kautiainen H.,Kujala U.M.,Lammentausta E.,J覿ms覿T.,Kiviranta I.,Nieminen M.T.,2015,Bone and cartilage characteristics in postmenopausal women with mild knee radiographic osteoarthritis and those without radiographic osteoarthritis,J.Musculoskelet.Neuronal Interact,15(1):69-77
Muraki S.,Akune T.,En-Yo Y.,Yoshida M.,Suzuki T.,Yoshida H.,Ishibashi H.,Tokimura F.,Yamamoto S.,Tanaka S.,Nakamura K.,Kawaguchi H.,Oka H.,and Yoshimura N.,2015,Joint space narrowing,body mass index,and knee pain:the ROAD study(OAC1839R1),Osteoarthritis Cartilage,23(6):874-881
Ren Z.S.,Cheng Z.J.,Sun H.J.,Sun Z.H.,Cui Z.J.,Zhang L.L.,Lin Y.Z.,Zhang R.Z.,Peng B.,and Zhang X.L.,2016,Osteoporosis-related factors in patients with knee osteoarthritis before total knee arthroplasty,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),20(22):3212-3218(任志帅,程招军,孙和军,孙振辉,崔子健,张黎龙,林雍智,张仁赞,彭兵,张学利,2016,膝骨关节炎全膝关节置换前骨质疏松的相关因素分析,中国组织工程研究,20(22):3212-3218)
Wang X.,and Xiong F.F.,2015,Correlation between fear of falling and quality of life in elderly patients with osteoporosis,Zhongguo Laonianxue Zazhi(Chinese Journal of Gerontolog),35(22):6571-6573(王雪,熊芳芳,2015,老年骨质疏松患者害怕跌倒心理与生活质量的相关性,中国老年学杂志,35(22):6571-6573)
Yamamoto Y.,Turkiewicz A.,Wingstrand H.,and Englund M.,2015,Fragility fractures in patients with rheumatoid arthritis and osteoarthritis compared with the general population,The J.Rheumatol.,42(11):2055-2058
Chen J.Y.,Cao X.W.,Guo D.,Huang W.K.,Liu J.,Ma Z.W.,and Pan J.K.,2015,Study on the correlation of micro perfusion,vascular invasion and cartilage degeneration of knee osteoarthritis,Shiyong Yixue Zazhi(The Journal of Practical Medicine),31(18):3063-3066(陈嘉怡,曹学伟,郭达,黄伟康,刘军,马振蔚,潘建科,2015,膝骨关节炎软骨下骨微灌注、血管侵入及软骨退变相关研究,实用医学杂志,31(18):3063-3066)
Chen X.Q.,Hu W.Y.,Lu B.,Li S.W.,Wang J.H.,and Zhang J.,2015,Total knee arthroplasty for terminal knee disease:short-term follow-up,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(26):4132-4138(陈小强,胡旺阳,陆斌,李苏皖,王金华,张健,2015,人工全膝关节置换修复晚期膝关节病变的短期随访,中国组织工程研究,19(26):4132-4138)
Chen Z.W.,Dai Z.,Liao Y.,and Tang Z.W.,2014,Study of the relationship between bone mineral density of the proximal femur and osteoporotic fractures in postmenopausal women,Zhongguo Guzhi Shusong Zazhi(Chinese Journal of Osteoporosi),20(12):1447-1449(陈志伟,戴祝,廖瑛,唐正午,2014,绝经后女性股骨近端骨密度与骨质疏松性骨折相关性研究,中国骨质疏松杂志,20(12):1447-1449)
Fu L.M.,Jiang G.W.,Ma Z.J.,Zhang S.H.,2015,Evaluation and influencing factors of knee function in aged patients withosteoarthritis before and after total knee arthroplasty,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(4):499-503(付立明,姜国旺,马兆吉,张生海,2015,全膝关节置换前后老年骨关节炎患者关节功能评估及影响因素,中国组织工程研究,19(4):499-503)
Gao W.L.,Ma Z.X.,Xu P.F.,and Yin Z.S.,2015,Epidemiology of total knee arthroplasta retrospec tive analysis among 1146cases in Hefei City from 2008 to 2013,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(4):504-509(高维陆,马志翔,许鹏飞,尹宗生,2015,全膝关节置换流行病学分析:2008至2013年合肥市1 146例回顾,中国组织工程研究,19(4):504-509)
Hao J.,and Quan Z.X.,2016,Imaging diagnosis of osteoporotic vertebral compression fractures,Zhonghua Chuangshang Zazhi(Chinese Journal of Traumatology),32(9):769-771(郝杰,权正学,2016,骨质疏松性椎体压缩骨折的影像学诊断,中华创伤杂志,32(9):769-771)
Ho L.B.,Kim T.H.,Chong H.S.,Lee S.H.,Park J.O.,Kim H.S.,Shim D.W.,Lee H.M.,and Moon S.H.,2015,Prognostic factors for surgical outcomes including preoperative total knee replacement and knee osteoarthritis status in female patients with lumbar spinal stenosis,J.Spinal Disord.Tech.,28(2):47-52
Jauregui J.J.,Cherian J.J.,Pierce T.P.,Beaver W.B.,Issa K.,and Mont M.A.,2015,Long-term survivorship and clinical outcomes following total knee arthroplasty,Journal of Arthroplasty,30(12):2164-2166
Kagotani R.,Yoshida M.,Muraki S.,Oka H.,Hashizume H.,Yamada H.,Enyo Y.,Nagata K.,Ishimoto Y.,Teraguchi M.,Tanaka S.,Nakamura K.,Kawaguchi H.,Akune T.,and Yoshimura N.,2015,Prevalence of diffuse idiopathic skeletal hyperostosis(DISH)of the whole spine and its association with lumbar spondylosis and knee osteoarthritis:the ROADstudy,J.Bone Miner Metab.,33(2):221-229
Li C.,Lv W.H.,Liu X.G.,Liu X.G.,Wang T.T.,Wang Z.F.,Xing Y.R.,Zheng L.L.,and Zhang L.X.,2015,The study of prevalence of osteoporosis in 1 088 medical workers,Zhongguo Guzhi Shusong Zazhi(Chinese Journal of Osteoporosis),21(10):1217-1220(李冲,吕伟华,刘晓钢,王亭亭,王志芳,邢玉荣,郑丽丽,张丽侠,2015,1 088例医务人员骨质疏松的流行病学研究,中国骨质疏松杂志,21(10):1217-1220)
Li n H.,and Xu Y.J.,2015,Perioperative intervention of osteoporotic fracture,Zhonghua Guke Zazhi(Chinese Journal of Orthopaedics),35(10):1022-1026(林华,徐又佳,2015,骨质疏松性骨折围手术期干预,中华骨科杂志,35(10):1022-1026)
Liu J.Q.,and Niu W.,2008,Progress in research on causes and pathogenic mechanism of arthritis in knee-pan,Changchun Zhongyiyao Daxue Xuebao(Journal of Changchun University of Traditional Chinese Medicine),24(3):344-345(刘加钱,牛维,2008,膝骨关节炎病因及发病机制研究进展,长春中医药大学学报,24(3):344-345)
Lv S.M.,and Zhang R.L.,2016,Epidemiological study of knee osteoarthritis in middle aged and elderly,Zhongguo Laonianxue Zazhi(Chinese Journal of Gerontology),36(16):4133-4135(吕苏梅,张瑞丽,2016,中老年膝骨关节炎的流行病学研究进展,中国老年学杂志,36(16):4133-4135)
Miller R.E.,Tran P.B.,Obeidat A.M.,Raghu P.,Ishihara S.,Miller R.J.,and Malfait A.M.,2015,The role of peripheral nociceptive neurons in the pathophysiology of osteoarthritis pain,Curr.Osteoporos.Rep.,13(5):318-326
Multanen J.,Heinonen A.,Hkkinen A.,Kautiainen H.,Kujala U.M.,Lammentausta E.,J覿ms覿T.,Kiviranta I.,Nieminen M.T.,2015,Bone and cartilage characteristics in postmenopausal women with mild knee radiographic osteoarthritis and those without radiographic osteoarthritis,J.Musculoskelet.Neuronal Interact,15(1):69-77
Muraki S.,Akune T.,En-Yo Y.,Yoshida M.,Suzuki T.,Yoshida H.,Ishibashi H.,Tokimura F.,Yamamoto S.,Tanaka S.,Nakamura K.,Kawaguchi H.,Oka H.,and Yoshimura N.,2015,Joint space narrowing,body mass index,and knee pain:the ROAD study(OAC1839R1),Osteoarthritis Cartilage,23(6):874-881
Ren Z.S.,Cheng Z.J.,Sun H.J.,Sun Z.H.,Cui Z.J.,Zhang L.L.,Lin Y.Z.,Zhang R.Z.,Peng B.,and Zhang X.L.,2016,Osteoporosis-related factors in patients with knee osteoarthritis before total knee arthroplasty,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),20(22):3212-3218(任志帅,程招军,孙和军,孙振辉,崔子健,张黎龙,林雍智,张仁赞,彭兵,张学利,2016,膝骨关节炎全膝关节置换前骨质疏松的相关因素分析,中国组织工程研究,20(22):3212-3218)
Wang X.,and Xiong F.F.,2015,Correlation between fear of falling and quality of life in elderly patients with osteoporosis,Zhongguo Laonianxue Zazhi(Chinese Journal of Gerontolog),35(22):6571-6573(王雪,熊芳芳,2015,老年骨质疏松患者害怕跌倒心理与生活质量的相关性,中国老年学杂志,35(22):6571-6573)
Yamamoto Y.,Turkiewicz A.,Wingstrand H.,and Englund M.,2015,Fragility fractures in patients with rheumatoid arthritis and osteoarthritis compared with the general population,The J.Rheumatol.,42(11):2055-2058