术前计算机断层扫描可以准确评估胫骨骨密度，为全膝关节置换术中选择固定骨提供依据。

IF 2.7 Q1 ORTHOPEDICS

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2025-05-05 DOI:10.1016/j.jisako.2025.100894

Yoshinori Mikashima , Hitoshi Imamura , Koichiro Yano , Katsunori Ikari , Hiroshi Takagi , Ken Okazaki

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引用次数: 0

摘要

前言/目的：胫骨近端骨的机械质量是无骨水泥全膝关节置换术（TKA）成功的重要因素。本研究的目的是通过计算机断层扫描（CT）评估全膝关节置换术中胫骨切除水平术前骨密度（胫骨BMD）与术中松质骨耐久性（ICBD）的关系。方法：对2024年4月至2024年10月同一外科医生连续实施的所有骨水泥和无骨水泥tka进行评估。所有患者术前均通过CT检查胫骨骨密度，双能x线骨密度（DEXA）检查髋关节骨密度。在胫骨中心取一块直径为10mm，高度为10mm的松质骨。术中根据宏观评估的骨质量选择固定方法。使用推式张力计和金属测量，测量将收获骨从10毫米压缩到5毫米所需的力，并将其定义为ICBD。计算Pearson积差相关性来评估ICBD与胫骨和髋关节骨密度之间的关系。结果：连续纳入74例tka。无骨水泥固定50例，骨水泥固定24例。无骨水泥组的平均ICBD、胫骨骨密度和髋关节骨密度显著高于骨水泥组(ICBD；胫骨骨密度：85.6±35.6 vs 49.8±18.1；髋部骨密度70.3±26.2 vs 37.5±14.4；87.3±11.8 vs 65.6±10.5,P < 0.01)。胫骨骨密度临界值显示无骨水泥假体为46.4 HA/cm3。ICBD与胫骨骨密度有很强的相关性（r = 0.88, P < 0.01），与髋部骨密度有很强的相关性（r = 0.62, P < 0.01）。结论：本研究首次报道了胫骨近端实际骨质量与基于ct的胫骨骨密度之间的关系。通过CT评估骨质量是准确的，相对简单的，并且可能有助于确定TKA是否需要无骨水泥固定。

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Preoperative computer tomography scans can accurately evaluate tibial bone mineral density for selecting bone fixation in total knee arthroplasty

Introduction/objective

The mechanical quality of bone at the proximal tibia is an important factor for the success of cementless total knee arthroplasty (TKA). The purpose of this study was to evaluate the relationship between preoperative bone mineral density (BMD) at the tibial resection level (tibial BMD) using computed tomography (CT) and intraoperative cancellous bone durability (ICBD) in TKA.

Methods

All consecutive cemented and cementless TKAs performed by a single surgeon between April 2024 and October 2024 were evaluated. All patients were examined preoperatively for tibial BMD via CT, hip BMD via dual-energy X-ray absorptiometry. A block of cancellous bone with a diameter of 10 mm and a height of 10 mm was harvested at the center of the tibia. The fixation method was selected intraoperatively according to the macroscopically evaluated bone quality. Using a pusher tension gauge and a metal measure, the force required to compress the harvested bone from 10 mm to 5 mm was measured and defined as ICBD. Pearson product-moment correlations were calculated to assess the relationships between tibial and hip BMD and ICBD.

Results

A consecutive series of 74 TKAs were included. There were 50 cementless fixations and 24 cemented fixations. Tibial BMD, hip BMD and mean ICBD were significantly greater in the cementless group than in the cemented group (tibial BMD: 70.3 ± 26.2 vs 37.5 ± 14.4, and hip BMD: 87.3 ± 11.8 vs 65.6 ± 10.5, ICBD: 85.6 ± 35.6 vs 49.8 ± 18.1, respectively, P < 0.01). The cut-off value of tibial BMD indicating a cementless prosthesis was 46.4 HA/cm³. There was a very strong correlation between tibial BMD and ICBD (r = 0.88, P < 0.01) and a strong correlation between hip BMD and ICBD(r = 0.62, P < 0.01).

Conclusion

This study is the first report to focus on the relationships between CT-based tibial BMD and the actual bone quality of the proximal tibia . Assessment of bone quality via CT is accurate, relatively simple, and potentially useful for determining whether cementless fixation in TKA is indicated. For cementless fixation, 46.4 HA/cm3 and 55.7 N were found as tibial BMD and ICBD cut-off values.