Total kalça protezi uygulanan hastaların kemik yoğunluk ölçümü ve femur rezeksiyon materyalinin histopatolojik sonuçlarının korelasyon açısından değerlendirilmesi
Küçük Resim Yok
Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çalışmanın amacı; ilk olarak tek taraflı koksartrozu olan hastalarda bilateral yapılan proksimal femur Dexa sonuçlarında artroz olan taraf ile normal tarafa kıyasla kemik mineral yoğunluğunda meydana gelen farklılıkları saptamaktı. İkinci olarak koksartroz olan proksimal femurda hangi bölgelerin daha fazla etkilendiğini ortaya çıkarmaktı. Son olarak da Total Kalça Artroplastisi (TKA) sonrasında alınan femur baş-boyun ve femoral ward örneklerinin histomorfometrik ölçümlerinin yapılarak elde edilen Dexa sonuçları ile korelasyonunu ortaya çıkarmaktı. İzlenen Methodoloji: Haziran 2021'den Ocak 2023'e kadar Tekirdağ Namık Kemal Üniversitesi Ortopedi ve Travmatoloji Anabilim Dalında TKA uygulanan 30 hasta dahil edildi. Hastaların bilateral proksimal femur Dexa ölçümleri Total ve bölgesel (femur boynu, trokanterik, intertrokanterik ve ward üçgeni) olarak yapıldı. Ölçümler artroplasti ameliyatından 2 hafta önce yapıldı. Proksimal femur baş ve boyun dahil olacak şekilde TKA sırasında çıkartıldıktan sonra femur başı, femur boynu ve femoral ward bölgelerinden 1 cm x 2 cm kemik numuneleri her bölgeden 3 adet olacak şekilde toplam 9 adet örnek alındı. Örnekler üzerinde histomorfometrik inceleme ile trabeküler kalınlık, trabeküler uzaklık, trabekül volümü/kemik volümü (% olarak), trabekül sayısı değerleri ortaya çıkartıldı. Normal dağılım olup olmadığının belirlenmesi için normalite testleri kullanıldı. Bilateral Dexa sonuçlarının değerlendirilmesi için Bağımlı Örneklem T- Testi kullanıldı. Histomorfometrik sonuçların ipsilateral Dexa sonuçları ile korelasyonu için Pearson korelasyon testi yapıldı. Araştırmanın Bulguları: Çalışmanın ilk aşamasında femur boyun ve femoral ward bölgesinde normal ve artroz olan kalça eklemi Dexa sonuçları arasında istatistiksel olarak anlamlı farklılıklar bulundu. Bu verilerin güvenilirliğini ortaya çıkarmak amacıyla yapılan koksartroz olan kalça ekleminin histomorfometrik değerlendirilmesinde femur boyun ve femoral ward bölgelerinde oluşan KMİ ve KMY artışının ölçülen parametrelerle korelasyon gösterdiği bulundu. Bu bölgelerde trabeküler kalınlık artışı, trabeküller arası mesafede azalma, trabekül sayısında azalma saptandı. Ayrıca trabekül kalınlığındaki artışın femoral ward bölgesinde daha fazla olduğu, trabeküller arası mesafede azalmanın ise femur boyun bölgesinde daha fazla olduğu diğer elde edilen sonuçlardır. Osteoartrit olan kadınlarda erkeklere göre histomorfometrik ölçümler değerlendirildiğinde düşük KMY, KMİ, T skoru ile sonuçlanan bulgular elde edildi. Araştırmanın Sonuçları: Osteoartritin kemik yapısında gerçekleştirdiği değişiklikler sürekli araştırılan bir konudur. Çalışmamızda koksartroz olan kalça ekleminde femur boyun ve femoral ward bölgesinde KMİ ve KMY'nun anlamlı derecede arttığı saptandı. Bu bölgelerin histomorfometrik incelemesinde osteoartrit bulgularının olduğu aynı bölgelerle korelasyon gösterdiği bulundu. Ayrıca makroskobik kemik kalitesini değerlendirme yöntemi olan Dexa'nın mikroskobik kemik değerlendirme kriteri olan kemik histomorfometrisi ile korele olduğu sonucuna ulaşıldı. Koksartrozda osteoartrit etkilerinin tam olarak ortaya çıkartılması için geniş vaka serili ileri çalışmalara ihtiyaç vardır.
The aim of this study is; firstly, to determine the differences in bone mineral density between the arthrosis side and the normal side in bilateral proximal femur Dexa results in patients with unilateral coxarthrosis. Secondly, to reveal which regions of the proximal femur are more affected in patients with coxarthrosis. Lastly, to make histomorphometric measurements of femoral head-neck and femoral ward specimens taken after Total Hip Arthroplasty (THA) and to correlate them with the Dexa results. Methodology: From June 2021 to January 2023, 30 patients who underwent THA at the Department of Orthopedics and Traumatology, Tekirdağ Namık Kemal University were included. Total and regional (femoral neck, trochanteric, intertrochanteric and ward triangle) Dexa measurements of the bilateral proximal femur were performed. Measurements were performed 2 weeks before arthroplasty surgery. After removal of the proximal femur including the head and neck during THA, 1 cm x 2 cm bone specimens were taken from the femoral head, femoral neck and femoral ward regions, with 3 specimens from each region, totaling 9 specimens. Histomorphometric examination was performed on the samples to determine trabecular thickness, trabecular distance, trabecular volume/bone volume (%) and trabecular number. Normality tests were used to determine whether there was a normal distribution. Dependent Sample T-Test was used for the evaluation of bilateral Dexa results. Pearson correlation test was used to correlate histomorphometric results with ipsilateral Dexa results. Results of the Study: In the first phase of the study, statistically significant differences were found between normal and arthritic hip Dexa results in the femoral neck and femoral ward region. Histomorphometric evaluation of the pathologic femur was performed to determine the reliability of these data and it was found that the increase in Bone Mineral Density (BMD) and Bone Mineral Content (BMI) in the femoral neck and femoral ward regions correlated with the measured parameters. Increased trabecular thickness, decreased inter-trabecular distance and decreased number of trabeculae were found in these regions. It was also found that the increase in trabecular thickness was greater in the femoral ward region and the decrease in inter-trabecular distance was greater in the femoral neck region. When histomorphometric measurements were evaluated in women with osteoarthritis compared to men, findings resulting in lower BMD, BMI and T score were obtained. Results of the Study: The changes in bone structure caused by osteoarthritis are a subject of continuous research. In this study, we found that BMI and BMD were significantly increased in the femoral neck and femoral ward region in coxarthrosis. Histomorphometric examination of these regions correlated with the same regions with osteoarthritis findings. It was also concluded that Dexa, a macroscopic bone quality assessment method, correlated with bone histomorphometry, a microscopic bone assessment criterion. Further studies with large case series are needed to fully reveal the effects of osteoarthritis in coxarthrosis.
The aim of this study is; firstly, to determine the differences in bone mineral density between the arthrosis side and the normal side in bilateral proximal femur Dexa results in patients with unilateral coxarthrosis. Secondly, to reveal which regions of the proximal femur are more affected in patients with coxarthrosis. Lastly, to make histomorphometric measurements of femoral head-neck and femoral ward specimens taken after Total Hip Arthroplasty (THA) and to correlate them with the Dexa results. Methodology: From June 2021 to January 2023, 30 patients who underwent THA at the Department of Orthopedics and Traumatology, Tekirdağ Namık Kemal University were included. Total and regional (femoral neck, trochanteric, intertrochanteric and ward triangle) Dexa measurements of the bilateral proximal femur were performed. Measurements were performed 2 weeks before arthroplasty surgery. After removal of the proximal femur including the head and neck during THA, 1 cm x 2 cm bone specimens were taken from the femoral head, femoral neck and femoral ward regions, with 3 specimens from each region, totaling 9 specimens. Histomorphometric examination was performed on the samples to determine trabecular thickness, trabecular distance, trabecular volume/bone volume (%) and trabecular number. Normality tests were used to determine whether there was a normal distribution. Dependent Sample T-Test was used for the evaluation of bilateral Dexa results. Pearson correlation test was used to correlate histomorphometric results with ipsilateral Dexa results. Results of the Study: In the first phase of the study, statistically significant differences were found between normal and arthritic hip Dexa results in the femoral neck and femoral ward region. Histomorphometric evaluation of the pathologic femur was performed to determine the reliability of these data and it was found that the increase in Bone Mineral Density (BMD) and Bone Mineral Content (BMI) in the femoral neck and femoral ward regions correlated with the measured parameters. Increased trabecular thickness, decreased inter-trabecular distance and decreased number of trabeculae were found in these regions. It was also found that the increase in trabecular thickness was greater in the femoral ward region and the decrease in inter-trabecular distance was greater in the femoral neck region. When histomorphometric measurements were evaluated in women with osteoarthritis compared to men, findings resulting in lower BMD, BMI and T score were obtained. Results of the Study: The changes in bone structure caused by osteoarthritis are a subject of continuous research. In this study, we found that BMI and BMD were significantly increased in the femoral neck and femoral ward region in coxarthrosis. Histomorphometric examination of these regions correlated with the same regions with osteoarthritis findings. It was also concluded that Dexa, a macroscopic bone quality assessment method, correlated with bone histomorphometry, a microscopic bone assessment criterion. Further studies with large case series are needed to fully reveal the effects of osteoarthritis in coxarthrosis.
Açıklama
Tıp Fakültesi, Ortopedi ve Travmatoloji Ana Bilim Dalı
Anahtar Kelimeler
Ortopedi ve Travmatoloji, Orthopedics and Traumatology
