骨密度在髋部骨质疏松性骨折风险评估中的价值

目的评估骨密度在髋部脆性骨折风险预测中的临床价值。方法回顾性研究2014年6月至2019年6月在我院创伤骨科住院的老年髋部骨折患者72例,作为病例组,其中股骨转子间骨折31例,股骨颈骨折41例;对照组选择同期我院骨外科门诊老年体检者63例。使用DXA方法测量患者腰椎和健侧髋部(全髋部、转子间、股骨颈、Ward’s区)的骨密度;对照组测量腰椎和左侧髋部骨密度,统计分析测量结果。结果①骨折组腰椎、髋部骨密度均显著低于对照组,差异有统计学意义(P0.01);②转子间骨折组和股骨颈骨折组在腰椎和髋部区域骨密度比较差异均无统计学意义(P 0.05);③骨折组与对照组在转子间区的T值降低比例最大为122.1%,腰椎降低幅度最小为31.3%,余髋部的T值均有不同程度降低;④骨折后髋部和腰椎T值比存在倒置现象;⑤对照组和骨折组髋部骨质疏松程度比较,差异有统计学意义(P0.01);两组患者腰椎骨质疏松程度比较,差异无统计学意义(P0.05)。结论①髋部骨折患者骨密度均显著低于体检者,提示骨密度与髋部骨折具有一定相关性,但与髋部骨折类型无关;②在髋部骨折风险评估中,髋部骨密度相比腰椎更有价值;③当髋部与腰椎T值比出现倒置时,将不可避免发生髋部骨折;④骨量正常的部分患者发生了脆性骨折,而骨质疏松的部分患者却未发生骨折,表明影响骨折发生的因素除了骨密度外,可能和骨骼的微结构有关。

The value of bone mineral density in assessing the risk of osteoporotic hip fractures

Objective To evaluate the clinical value of bone mineral density (BMD) in predicting the risk of osteoporotic hip fractures. Methods Seventy-two elderly patients with hip fractures in the trauma department of our hospital were retrospectively studied from June 2014 to June 2019. There were 31 cases of intertrochanteric fractures and 41 cases of femoral neck fractures. Sixty-three geriatric patients in our orthopedic clinic during the same period were selected as the control group. BMD of the lumbar spine and uninjured hip (total hip, intertrochanteric, femoral neck, and Ward area) was measured with DXA method. BMD of the lumbar and left hip was measured in the control group. The results were statistically analyzed. Results (1) BMD of the lumbar spine and hip in the fracture group was significantly lower than that in the control group, with statistically significant difference (P<0.01). (2) There were no statistically significant differences in BMD of the lumbar spine and hip between the intertrochanteric fracture group and the femoral neck fracture group (P>0.05). (3) The maximum reduction of T value at intertrochanteric area between fracture group and control group was 122.1%. The minimum reduction of T value at the lumbar was 31.3%. (4) The ratio of T value at the hip and lumbar spine was inverted after fracture. (5) The degree of hip osteoporosis between the control group and the fracture group was statistically significant (P<0.01). There was no significant difference in the degree of lumbar osteoporosis between the two groups (P>0.05). Conclusion (1) BMD of patients with osteoporotic hip fractures was significantly lower than that of patients without fractures, indicating that BMD was correlated with hip fracture to some extent, but it was not correlated with the type hip fractures. (2) In the risk assessment of hip fractures, BMD of the hip is more valuable than that of the lumbar vertebrae. (3) When the ratio of T value between the hip and the lumbar spine is inverted, the occurrence of hip fracture is inevitable. (4) Fragile fractures occur in some patients with normal bone mass, while some patients with osteoporosis do not have fractures, suggesting that the factors affecting the occurrence of fractures may be related to bone microstructure in addition to BMD.