老年膝骨关节炎患者膝关节肌力与骨密度相关性分析

目的探讨老年膝骨关节炎(knee osteoarthritis,KOA)患者膝关节肌力与骨密度(bone mineral density,BMD)的相关关系。方法采用多关节等速力量测试与训练系统测试老年KOA患者膝关节肌力;采用双能X线骨密度仪检测老年KOA患者BMD,并分析两者之间的关系。结果 (1)老年KOA患者主患侧伸膝肌群峰力矩、相对峰力矩均显著低于对侧。(2)老年KOA患者双侧膝关节肌力部分指标与BMD相关,在等长等速模式下,伸膝肌群峰力矩与髋关节以及L1-L4 BMD呈正相关;屈膝肌群峰力矩与股骨颈、髋关节以及L1-L4 BMD呈正相关。(3)老年KOA患者主患侧膝关节肌力部分指标与BMD有一定相关性,在等速模式下,屈膝肌群峰力矩以及相对峰力矩与主患侧髋关节以及股骨颈BMD呈正相关;在等长等速模式下,伸膝以及屈膝肌群峰力矩与L1-L4 BMD呈正相关。结论老年KOA患者膝关节肌力与骨密度之间存在相关性。加强膝关节肌力锻炼,特别要加强主患侧屈膝肌群肌力锻炼,可能会提高髋关节、股骨颈以及腰椎BMD,从而预防骨质疏松。     

绝经后妇女膝关节骨性关节炎骨密度的临床研究

目的 通过测量膝关节骨性关节炎患者桡骨远端和跟骨骨密度,探讨膝关节骨性关节炎患者骨密度的特征及膝关节骨性关节炎与骨质疏松症的关系.方法 对100例绝经后妇女膝关节骨性关节炎患者分别测量桡骨远端和跟骨的骨密度.所有患者均按kellgren分级标准对膝关节进行评分.结果 绝经后妇女膝关节骨性关节炎患者桡骨远端和跟骨的骨密度值随kellgren分级级数的增高差异无显著性.以低于同性别同部位峰值骨量的2.0 SD为骨质疏松诊断标准,桡骨远端和跟骨符合骨质疏松症诊断率分别为51%和46%.桡骨远端骨密度与体重指数的相关系数为0.3630(P<0.01).结论 绝经后妇女膝关节骨性关节炎患者伴发骨质疏松症的比例较高,且随年龄增高有不断增高的趋势.膝关节骨性关节炎患者的骨密度与体重指数呈正相关.     

中老年女性骨关节炎患者骨密度的特点

目的　通过测量骨关节炎患者腰椎和髋部骨密度 ,探讨骨关节炎患者骨密度的特点及骨关节炎与骨质疏松症的关系。方法　本组研究对象均为中老年女性膝关节骨关节炎患者 ,其中 5 9例测量了腰椎和髋部骨密度 ,12例仅测量了腰椎骨密度。所有患者均按Kellgren分级标准对膝关节进行了评分。结果　绝经后妇女膝关节X线评分随Kellgren分级级数的增高患者腰椎骨密度均值逐渐增高 ,4级骨关节炎患者腰椎骨密度均值明显高于 2级患者 (P <0 0 5 ) ,而髋部骨密度均值随Kellgren分级级数的增高差异无显著性。如以低于同性别同部位峰值骨量的 2 0SD为骨质疏松诊断标准 ,腰椎和髋部符合骨质疏松症诊断的分别为 4 3 7%和 77%。在控制年龄和骨关节炎的影响后 ,股骨颈骨密度与体重指数的偏相关系数为 0 4 0 7(P <0 0 1)。结论　中老年女性骨关节炎患者中同时患有骨质疏松症的比例较高 ,同髋部骨密度测量相比 ,腰椎骨密度测量受骨关节炎影响较大。     

膝骨性关节炎与骨质疏松相关性研究概述

膝关节骨性关节炎(KOA,knee osteoarthritis)是一种以膝关节软骨退变和继发性骨质增生为特征的慢性关节疾病,骨质疏松症(OP,osteoporosis)是以骨量减少,骨组织微细结构破坏,进而出现骨的脆性增高和骨折危险性增加为特征的一种全身性骨骼疾病。上述两种不同的骨科常见疾病,其二者间相关关系是近年来讨论热点,目前针对二者间关系不同学者持有不同观点:正相关、负相关、不相关。为此笔者通过收集近年来国内外相关文献,以期明确二者间关系,进而更好地指导临床治疗此两种疾病。     

骨质疏松症合并膝骨性关节炎患者骨密度及血清骨代谢指标、炎症因子水平研究

目的观察绝经后骨质疏松症(osteoporosis,OP)合并膝骨性关节炎患者骨密度、骨代谢相关指标以及细胞因子水平的特点。方法纳入78例绝经后骨质疏松症患者为OP组,75例绝经后骨质疏松症合并膝骨性关节炎患者为OPA组,76例膝骨性关节炎患者为KOA组。观察3组患者血清骨代谢指标骨钙素(BGP)、血清抗酒石酸酸性磷酸酶异体(TRACP-5b)、骨碱性磷酸酶(BAP)及I型胶原交联C末端肽(CTX-1)水平;炎症因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β1 (TGF-β1)及白细胞介素-10(IL-10)水平以及左髋、正位腰椎1-4(L1～4)的骨密度情况。结果 OPA组血清BGP、TRACP-5b、BAP、BGP、CTX-1水平高于OP组(P0. 05),而KOA组低于OP组(P0. 05)。KOA组血清TGF-β1水平高于OP组(P0. 05),而血清IL-6、TNF-α及IL-10水平显著低于OP组(P0. 05); KOA组血清IL-6、TNF-α及IL-10水平高于OP组(P0. 05),而TGF-β1水平低于OP组(P0. 05)。OP组及OPA组L1-4及左髋部骨密度显著低于KOA组(P0. 05)。结论绝经后骨质疏松症合并膝骨性关节炎患者的骨密度及骨代谢不同程度减低,而细胞因子水平升高,治疗时需要关注免疫异常。     

单室膝关节置换术治疗早期膝骨性关节炎

骨性关节炎 (ｏｓｔｅｏａｒｔｈｒｉｔｉｓ,ＯＡ)早期常是从侵犯膝关节某一单室开始的 ,首先是关节软骨某一负重区域破坏 ,继而产生关节面的不平整、关节不稳、关节面磨损加快 ,久而久之破坏全关节。如何合理地仅治疗病变的单室而保留膝关节韧带和尚完好的软骨 ,或者置换那些仅有膝关节单室部分骨质缺损或塌陷的情况 ,从而阻断或延缓多室关节炎的形成 ,这正是实施单室膝关节置换术 (ｕｎｉｃｏｍｐａｒｔｍｅｎｔａｌｋｎｅｅａｒｔｈｒｏｐｌａｓｔｙ ,ＵＫＡ )的目的。该手术以其具有的切除骨质少、植入异物少、手术时间短、手术创伤和并…     

全膝关节表面置换术治疗膝骨性关节炎

目的分析人工全膝表面置换治疗膝骨性关节炎的临床效果。方法对21例29膝的膝骨性关节炎病例行人工膝关节置换术,单膝关节置换13例,双膝关节置换8例,全部采用后方稳定性假体。结果随访6~47个月,平均22.6个月,采用HSS评分系统进行分析,优15例,良5例,可1例。患者术后在疼痛、功能方面都有明显改善。结论全膝关节表面置换术对治疗严重膝骨性关节炎效果满意。术中精确的截骨操作、正确的软组织松解及术后指导康复是手术治疗成功的关键。     

血清Chemerin水平与骨质疏松症患者骨密度的相关性研究

目的评估骨质疏松症患者和健康对照者血清chemerin水平,探讨血清chemerin水平与骨密度(bone mineral density,BMD)的关系。方法选取2017年1月至2018年2月在西宁市第二人民医院门诊就医的200名参与者,进行年龄和性别匹配的病例对照研究。Pearson相关性检验用于调查血清chemerin水平与BMD之间的关系。结果分为骨质疏松组100例,对照组100例。骨质疏松组患者血清chemerin水平[(87. 65±5. 57) ng/m L]显著高于对照组[(70. 09±5. 16) ng/m L],差异有统计学意义(P0. 01)。两组股骨骨密度与chemerin呈负相关(骨质疏松组:r=-0. 394,P0. 01;对照组:r=-0. 679,P0. 01);两组腰椎骨密度与chemerin也呈负相关(骨质疏松组:r=-0. 305,P0. 01;对照组r=-0. 361,P0. 01)。结论骨质疏松症患者血清chemerin水平升高,与BMD呈负相关。需进一步研究chemerin在骨质疏松症病理生理中的作用。     

绝经后妇女膝关节骨性关节炎与骨质疏松症的相关性研究

目的探讨绝经后妇女膝关节骨性关节炎与骨质疏松症的相关性。方法对134例绝经后妇女膝关节骨性关节炎患者行年龄、体重、身高及体重指数的计算和骨密度的测定。行双膝关节负重正位X线拍片,按照骨关节炎Kellgren分级标准将骨性关节炎患者分为4级,根据患者的临床症状和X线表现不同把4级骨性关节炎分成轻度组和重度组。分析膝关节骨性关节炎与其伴发的骨质疏松症的相关性。结果绝经后妇女患者的骨密度与年龄呈负相关,与体重、身高及体重指数呈正相关。重度组和轻度组相比较在身高、体重及体重指数上无显著性差异(P0.05),在年龄与股骨颈骨密度上有极显著性差异(P0.01)。股骨颈骨密度线性回归分析表明年龄对股骨颈骨密度的影响较大,因此用协方差分析排除年龄混杂因素对股骨颈骨密度的影响,重度组和轻度组在股骨颈骨密度上仍有显著性差异(P0.05)。结论绝经后妇女骨质疏松症与膝关节骨性关节炎的严重程度密切相关,膝关节骨性关节炎越严重,骨密度越低。骨性关节炎可能是骨质疏松症发生或加重的危险因素之一。     

膝关节骨性关节炎与骨质疏松症的相关性研究

目的 探讨绝经后妇女膝关节骨性关节炎与骨质疏松症的相关性.方法 对100名绝经后妇女膝关节骨性关节炎患者进行年龄、体重指数计算和骨密度的测定,双膝关节负重正位X线拍片,观察膝关节骨性关节炎与伴发骨质疏松症时各项指标的变化.结果 绝经后妇女随年龄增高膝关节骨性关节炎与伴发骨质疏松症的发生率上升.膝关节骨性关节炎体重指数明显大于膝关节骨性关节炎伴发骨质疏松症患者.膝关节骨性关节炎体重指数较高时伴发骨质疏松症可能性小;膝关节骨性关节炎体重指数较低时伴发骨质疏松症可能性增加.体重指数与骨密度呈正相关.结论 绝经后妇女膝关节骨性关节炎与其伴发骨质疏松的发生率与增龄有密切的关系.     

Subchondral tibial bone mineral density predicts future joint space narrowing at the medial femoro-tibial compartment in patients with knee osteoarthritis

Preliminary studies have shown that dual-energy X-ray absorptiometry (DXA) produces images of sufficient quality for a precise and accurate measurement at density of the subchondral bone. The objective of this study was to investigate the relationship between baseline subchondral tibial bone mineral density (BMD) and joint space narrowing observed after 1 year at the medial femoro-tibial compartment of the knee joint. Fifty-six consecutive patients, from both genders, with knee osteoarthritis diagnosed according to the American College of Rheumatology criteria, were included in the study. Radiographic posteroanterior views were taken, at baseline and after 1 year of follow-up. Minimum joint space width (JSW) measurement, at the medial femoro-tibial joint, was performed with a 0.1-mm graduated magnifying lens. Baseline BMD of the subchondral tibial bone was assessed by DXA. The mean +/- SD age of the patients was 65.3 +/- 8.7 years, with a body mass index of 28.0 +/- 4.9 kg/m(2). The minimum JSW was 3.5 +/- 1.5 mm and the mean BMD of the subchondral bone was 0.848 +/- 0.173 g/cm(2). There was a significant negative correlation between subchondral BMD and 1-year changes in minimum JSW (r = -0.43, p = 0.02). When performing a multiple regression analysis with age, sex, body mass index, and minimum JSW at baseline as concomitant variables, BMD of the subchondral bone as well as JSW at baseline were independent predictors of 1-year changes in JSW (p = 0.02 and p = 0.005, respectively). Patients in the lowest quartile of baseline BMD (<0.73 g/cm(2)) experienced less joint space narrowing than those in the highest BMD quartile (>0.96 g/cm(2)) (+0.61 +/- 0.69 mm versus -0.13 +/- 0.27 mm; p = 0.03). Assessment of BMD of the subchondral tibial bone is significantly correlated with future joint space narrowing and could be used as a predictor of knee osteoarthritis progression.     

Distribution of bone mineral density at the proximal tibia in knee osteoarthritis

One hundred and thirteen knees with osteoarthritis (OA) were studied to assess the distribution of bone mineral density (BMD) in the proximal tibia and the potential relation between osteoarthritis and osteoporosis in evaluating hip BMD. All patients had severe knee pain and were diagnosed with Kellgren and Lawrence grade IV osteoarthritis. According to the magnitude of the axial deformity, four categories were created: varus>10 degrees ( 28.3%), varus 4-10 degrees (38.9%), aligned 180 +/- 3 degrees (13.3%), and valgus>4 degrees (19.5%). For each category, the medial and lateral proximal tibial density were assessed. BMD was measured at the femoral neck and at 14 regions of interest (ROI) in the proximal part of the tibia using dual X-ray absorptiometry. Based on the femoral neck BMD, patients were classified according to the World Health Organization (WHO) definition of osteoporosis. The mean knee BMD was positively correlated with the hip BMD value (knee BMD m = 0.38 + 0.73 x hip BMD, r = 0.60, P<0.001). The knee BMD distribution of the 113 patients was negatively correlated with the axial deformity (BMD MT-LT = 5.15 - 0.027 x HKA, r = 0.77, P<0.0001). In the varus deformity, BMD of the medial side was higher than that of the lateral side with an important asymmetry (0.587 g/cm2). This asymmetry was also found in the valgus deformity for the lateral side but was less important (-0.112 g/cm2). With equal deformity, the asymmetry of BMD was higher in varus deformity (0.587 g/cm2) than in valgus deformity (-0.112 g/cm2). Asymmetry of the knee BMD distribution revealed that progression of the deformity (either varus or valgus) with joint space narrowing led to an increase in the medio-lateral difference of the proximal tibia density. Lesser severity of Kellgren and Lawrence grades may reveal different results. Twenty patients with osteoporosis developed knee osteoarthritis (OA) and the relation between osteoporosis and knee OA remains unclear.     

Forearm bone mineral density in postmenopausal women with osteoarthritis of the knee

The aims of the present study were to clarify whether postmenopausal women with osteoarthritis (OA) of the knee show higher bone mineral density (BMD) than healthy controls, and to investigate the relationship between BMD and the Kellgren and Lawrence radiological grade in postmenopausal women with OA of the knee. A total of 674 postmenopausal women, 46–90 years of age, were enrolled in the study: 305 patients with OA of the knee and 369 healthy controls. Forearm (distal radius) BMD, measured by dual-energy X-ray absorptionetry (DXA), using a DTX-200 (Osteometer), was significantly higher in the OA group than in the control group (P < 0.001), even when adjusted for age, height, body weight, body mass index, years since menopause, and grip strength (P < 0.01). Analysis of variance (ANOVA) with Fisher's protected least significant difference (PLSD) test showed that BMD in radiological grades 2, 3, and 4 was significantly higher than that in grade 1 (P < 0.05, P < 0.001, and P < 0.05, respectively), and BMD in grade 3 was significantly higher than that in grade 2 (P < 0.01), but BMD in grade 4 was significantly lower than that in grade 3 (P < 0.05). These findings suggest that forearm BMD appears to be significantly higher in postmenopausal women with OA of the knee than in healthy controls. Although BMD may be increased in low to moderate radiological grades of OA, severe grade OA may not always develop from moderate grade OA. Some cases of severe grade OA may be associated with low BMD. Received: May 1, 2001 / Accepted: September 26, 2001     

血清胃饥饿素、脂肪因子与膝骨关节炎患者骨密度的相关性研究

目的探讨血清胃饥饿素、脂肪因子水平与膝骨关节炎(knee osteoarthritis)患者骨密度(bone mineral density,BMD)之间的相关性。方法本研究选取了164例有症状的膝骨关节炎患者和100位健康人群(对照组)。使用酶联免疫吸附试验(ELISA)测量受试者血清胃饥饿素、脂联素和抵抗素水平。通过双能X线吸收测定法(DXA)测量受试者全身、腰椎、髋部和股骨的BMD。结果膝骨关节炎受试者的全身、腰椎、髋关节、股骨的BMD水平低于对照组(P均<0.05);但脂联素及胃饥饿素水平明显高于对照组(P均<0.05);在单因素分析中,血清胃饥饿素水平与所测量各个部位的骨密度之间有显著的负相关性(P<0.05);脂联素与股骨干骨密度和总股骨骨密度呈显著负相关(P<0.05)。进一步调整年龄、性别、体质量指数(body mass index,BMI)和骨关节炎(osteoarthritis,OA)后,胃饥饿素水平与各个部位的骨密度之间仍然存在显著负相关(P<0.05);脂联素与股骨干、股骨的骨密度之间有显著的相关性(P<0.05)。而血清抵抗素与各部位骨密度在混杂因素调整前后未发现显著相关性。结论血清胃饥饿素和脂联素水平与BMD呈显著负相关,提示胃饥饿素和脂联素对膝骨关节炎患者BMD有潜在的不利影响。     

Association between bone mineral density distribution and various radiographic parameters in patients with advanced medial osteoarthritis of the knee

PurposePatients with severe osteoarthritis (OA) of the knee have changes in bone mineral density (BMD) of the distal femur and proximal tibia. Correlations between the medial-to-lateral BMD (M/L-BMD) ratio (which normalizes the potentially confounding effects of body size and sex on BMD) and radiographic parameters that indicate OA progression have not been adequately studied. The purpose of this study was to evaluate correlations between radiographic indicators of OA progression and femoral and tibial M/L-BMD ratios.MethodsA consecutive series of 182 knees in 156 patients with advanced medial knee OA who underwent total knee arthroplasty were included. We evaluated correlations between the femoral and tibial M/L-BMD ratios and various radiographic parameters, including tibiofemoral angle (TFA), mechanical axis angle (MAA), tibial coronal angle, tibiofemoral subluxation (%), load-bearing axis deviation at the tibial plateau (%), and medial and lateral laxity.ResultsUnivariate analyses using Spearman's correlation coefficient revealed significant positive correlations between femoral and tibial M/L-BMD ratios and both TFA and MAA and negative correlations with tibial coronal angle and load-bearing axis deviation. Multivariate analyses showed significant associations between TFA and the femoral M/L-BMD ratio (β = 0.434, p < 0.001) and between MAA and the tibial M/L-BMD ratio (β = 0.384, p < 0.001).ConclusionBMD distribution around the knee might be predictable with radiographic parameters such as the TFA for the femur and MAA for the tibia. The findings of this study provide in vivo data on the evaluation of preoperative femoral and tibial M/L-BMD ratios without dual-energy X-ray absorptiometry.     

The predictive significance of bone mineral density on postoperative pain relief in knee osteoarthritis patients after total knee arthroplasty: A prediction model

BackgroundBone mineral density (BMD) may be an important factor affecting the clinical outcomes after total knee arthroplasty (TKA). However, further information regarding BMD in postoperative pain relief is not present yet. This study aims to gain further insight into the predictive significance of BMD in postoperative pain relief in knee osteoarthritis (KOA) patients after TKA.Methods156 KOA patients treated by TKA were included in this study. Visual analogue scale (VAS) was used to measure the pain intensity in patients within one year after TKA. The patients were divided into good pain relief group (the improvement of VAS ≥ 3) and poor pain relief group (the improvement of VAS < 3). BMD and other clinical characteristics were also collected. Logistic regression analysis and receiver operating characteristic curve (ROC curve) were used to evaluate the predictive significance of BMD. Subgroup analysis was used to compare the difference of postoperative pain between High BMD group and Low BMD group extra.Results34 (21.8%) patients had poor pain relief after TKA. Logistic regression analysis indicated that age, BMD, preoperative hospital for special surgery (HSS) scores, preoperative VAS score and postoperative posterior slope angles (PSA) were the risk factors of poor pain relief (P < 0.05). Using BMD as a predictor, the optimum cut-off value of poor pain relief was T-level = ?3.0 SD in the ROC curve, where sensitivity and specificity were 73.5% and 83.7%, respectively. Based on this cut-off value, obvious pain relief was observed in the High BMD group compared with Low BMD group from the 6th month after TKA in the subgroup analysis (P < 0.05).ConclusionsBMD is an effective predictor for postoperative pain relief in KOA patients after TKA, and the poor pain relief should be fully considered especially when BMD T-level ≤ ?3.0 SD.     

Altered bone mineral metabolism in patients with osteoarthritis

OBJECTIVE: Investigation of the relationship between osteoarthritis (OA) and mineral density, and determination of any alteration in bone mineral, metabolism as assessed by biochemical markers of bone resorption and formation. METHODS: Forty females and 20 males were included in the study. Spinal OA as well as knee OA were defined from radiographs and graded according to Lane et al.'s and Spector et al.'s scoring systems. Bone mineral density (BMD) of the lumbar spine was measured by osteo CT. Bone turnover rates were estimated by measuring biochemical markers of bone resorption (urinary deoxypyridinoline) and bone formation (bone-specific alkaline phosphatase). Forty females and 20 males of the same age were studied as a control group. RESULTS: BMD was greater in women with spinal OA as compared to controls (P < 0.05). Also, males with OA had a non-significantly higher BMD than controls. The bone resorption markers were higher than normal values. However, they were lower than the control group. Similarly, the bone formation markers were lower as compared to the control group. CONCLUSION: Spinal OA is associated with higher BMD. This protective effect of spinal OA against osteoporosis may be mediated through decreased rate of bone turnover.