股骨近端不同平面皮质骨厚度值、X射线灰度值与女性髋部脆性骨折的相关性

文题释义：脆性骨折：是指在无创伤或较微创伤情况下引起的骨折，一般是指在平地或人体站立高度下活动过程中发生的骨折，X射线下常可见骨骼有骨质疏松征象，也称为骨质疏松性骨折。 髋部骨折：是指发生在髋部及周围的骨折，包括股骨颈骨折、股骨转子间骨折、转子间骨折及髋臼骨折等，是骨质疏松性骨折最常发生的骨折部位，患者常因高龄且伴有基础疾病而1年内死亡率可达50%，5年存活率为20%。 背景：随着人口老龄化，脆性骨折疾病受到临床越来越多的关注，骨密度值的单独使用已经不能满足临床对脆性骨折的风险评估。目前骨皮质厚度作为评估脆性骨折发生风险的新方向和新方法之一，受到越来越多学者的研究和讨论。 目的：探讨在X射线DR摄影下，股骨近端不同平面骨皮质厚度值、X射线灰度值与50岁以上女性髋部脆性骨折的相关性，以此探寻股骨近端不同平面中，用于预测女性髋部脆性骨折发生风险最合适的测量平面。 方法：依照纳入标准收集2018年7月至2019年6月在广西医科大学第九附属医院放射科行X射线DR骨盆正位片检查的50岁以上女性患者100例的相关临床资料。所有患者对试验方案均知情同意，且得到医院伦理委员会批准。股骨近端骨皮质厚度值的测量平面设计为股骨颈中段、小转子上1 cm以内和小转子下1 cm以内，共3个测量平面。X射线灰度值测量以大转子和小转子的中点连线作为矩形对角线取矩形区域测量。 结果与结论：①50-64岁年龄组记为A组，65岁及以上年龄组记为B组，每组各50例；② B组患者的小转子上1 cm以内和小转子下1 cm以内平面的骨皮质厚度值、X射线灰度值比A组低，骨折率比A组高，差异均有显著性意义(P < 0.05)；而股骨颈中段平面的骨皮质厚度值2组间比较差异无显著性意义(P > 0.05)；③骨皮质厚度值的测量平面比较，骨皮质厚度测量值在整体上由高到低依次为小转子下1 cm以内、小转子上1 cm以内和股骨颈中段平面，差异有显著性意义(P < 0.05)；④观察对象小转子下1 cm以内及小转子上1 cm以内骨皮质厚度值、X射线灰度值、年龄，与脆性骨折相关系数依次为-0.303，-0.205，-0.272及0.346(P < 0.05)，但股骨颈中段平面皮质骨厚度与脆性骨折无明显相关性(P > 0.05)；⑤A组中骨折和非骨折患者小转子上1 cm以内和小转子下1 cm以内测量平面的骨皮质厚度值比较差异有显著性意义(P < 0.05)；B组中骨折和非骨折患者各指标比较差异均无显著性意义(P > 0.05)；在50岁以上的所有患者中，骨折和非骨折患者各测量平面的骨皮质厚度值和X射线灰度值的比较差异均有显著性意义(P < 0.05)；⑥说明骨皮质厚度值变薄，X射线灰度值变小，则髋部脆性骨折可能性变高。利用股骨近端骨皮质厚度评估50岁以上女性髋部脆性骨折风险时，推荐在股骨小转子下1 cm以内平面进行测量。 ORCID: 0000-0003-1961-7468(覃海阔) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Correlation of cortical bone thickness and X-ray gray value in different planes of proximal femur with brittle fracture of female hip

BACKGROUND:With the aging of population,brittle fracture diseases have attracted more and more attention from clinicians.Bone mineral density detection cannot meet the risk assessment of brittle fracture.As one of the new directions and methods to evaluate the risk of brittle fracture,cortical thickness has been studied and discussed by more and more scholars.OBJECTIVE:To explore the correlation of bone cortical thickness values and X-ray gray values in different planes of proximal femur with hip brittle fracture in women aged over 50 years old under X-ray DR photography,so as to evaluate the most appropriate measurement plane for predicting the risk of hip brittle fracture in women among different planes of proximal femur.METHODS:According to the inclusion criteria,relevant clinical data of 100 female patients aged over 50 years old who underwent X-ray DR pelvic radiograph examination at Department of Radiology of the Ninth Affiliated Hospital of Guangxi Medical University from July 2018 to June 2019 were collected.All patients signed the informed consents and the study was approved by the ethics committee of the hospital.The measurement planes of cortical thickness of the proximal femur were designed to be the middle part of femoral neck,within 1 cm above the lesser trochanter,and within 1 cm below the lesser trochanter,with a total of three groups of measurement planes.The gray value of X-ray was measured by taking the line between the middle point of the great rotor and the small rotor as the rectangular diagonal line to take the rectangular area for measurement.RESULTS AND CONCLUSION:(1)Women aged 50-64 years were as group A(n=50)and those aged 65 years and older were as group B(n=50).(2)The cortical thickness and X-ray gray value within 1 cm below the lesser trochanter,and within 1 cm above the lesser trochanter in the group B were significantly lower than those in the group A;fracture rate was higher in group A than in group B(P<0.05).There was no significant difference in the cortical thickness of middle part of the femoral neck between two groups(P>0.05).(3)On the whole,cortical thickness values were highest in the within 1 cm below the lesser trochanter,followed by within 1 cm above the lesser trochanter and lowest in the middle part of the femoral neck(P<0.05).(4)The correlation coefficient of cortical thickness and X-ray gray value of the within 1 cm below the lesser trochanter and within 1 cm above the lesser trochanter and age to brittle fracture was-0.303,-0.205,-0.272,and 0.346(P<0.05).There was no significant correlation between cortical thickness of middle part of the femoral neck and brittle fracture(P>0.05).(5)The difference of cortical thickness within 1 cm below the lesser trochanter and within 1 cm above the lesser trochanter between fracture and non-fracture groups in the group A was significant(P<0.05).There was no significant difference in each index between fracture and non-fracture groups in the group B(P>0.05).At the age above 50 years,the difference of cortical thickness and X-ray gray value in each measured plane between fracture and the non-fracture groups was significant(P<0.05).(6)To conclude,the cortical thickness becomes thinner and the gray value of X-ray becomes smaller,and the possibility of brittle fracture of hip becomes higher.When assessing the risk of hip fracture in women aged over 50 years using cortical thickness of the proximal femur,measurement within 1 cm below the lesser trochanter is recommended.