老年股骨粗隆间骨折患者骨密度及骨强度指标的相关研究

目的比较老年股骨粗降间骨折患者与无骨折人群的骨密度及骨强度指标，分析导致骨折的可能危险㈥素，寻找预防骨折发生的可靠指标，方法分别将66例老年股骨粗隆间骨折患者及65例未发生骨折患者分为骨折组和对照组，存其人院后应用双能X线吸光测定法（DXA）测定其骨密度，随后应用髋关节结构分析软件（HSA）计算所有患者的骨强度指标，应用SPSS18．0统计软件进行统计学分析。结果校正年龄后两组间股骨颈和股骨粗隆间骨密度BMD值以及骨强度指标中的横截面转动惯量、截面模量Z值、屈曲比率、皮质骨厚度以及髋关节轴线长度差异均具有统计学意义（其中髋关节辅线长度P=0．021，其余各项指标p值均=0．000），而股骨颈干角存两组间差异无统计学意义（P=0．127），继续加入相应部位骨密度BMD值校正后两组间所有的骨强度指标都失去了统计学意义（P值均〉0．05）。年龄的增加以及体质指数（BMI）、股骨颈截面模量Z值、股骨颔皮质骨厚度的减小与老年股骨粗隆间骨折的发生正相关（P值分别为0．013、0．032、0．001、0．000）。结论骨强度指标联合骨密度对老年股骨粗隆间骨折风险预测有重要意义。年龄的增加以及BMI、股骨颈截面模量Z值、股骨颈皮质骨厚度的减小会增加老年股骨粗隆间骨折发生的风险。

Research of the bone mineral density and bone strength indicators of aged patients with intertrochanteric fractures

Objective Comparing the bone mineral density （BMD） and bone strength indicators between aged patients with intertrochanteric fractures and patient without fractures to find probable risk factors of fractures and reliable indicators which can prevent fractures. Methods Sixty-six aged patients with intertrochanteric fractures and 65 patients without fractures were classified to the fracture group and the control group. The bone mineral density was measured by Dual-energy X-ray Absorbtiometry （DXA） after admission. Then bone strength indicators were calculated by the hip structure analysis （ HSA ）. The data was statistically analyzed by SPSS18.0. Results There were statistically significant differences after adjustment for age when comparing the BMD and the bone strength indicators, including the cross-sectional moment of inertia （CSMI）, section modulus （Z score）, buckling ratio （BR）, cortical thickness （CT） and hip axis length （HAL） of the narrow neck and intertrochanteric region between the two groups （the P value of the HAL was 0.021, the P value of rest indicators were all 0.000）. There was no significant difference in the neck shaft angle （ NSA ） between the two groups （the P value was 0.127）. But all the indicators lost significant difference after adjustment for BMD in each region （the P value of each indicator is greater than 0.05）. Advancing age and the decreasing of BMI, section modulus and cortical thickness in the narrow neck region had significant positive correlation with intertrochanteric fractures （P values were 0.013, 0.032, 0.001, 0.000 respectively ）. Conclusion Bone strength indicators together with BMD had important value of predicting the risk of intertrochanteric fractures. Advancing age and decreasing BMI, section modulus and cortical thickness in the narrow neck region may increase the risk of intertrochanteric fractures.