上海地区2591例双能X线骨密度测量分析

目的分析骨密度(BMD)及骨质疏松(OP)患病变化规律。方法采用双能X线骨密度仪检测上海地区2591例桡骨远端1/3BMD,年龄范围20～80岁。按5岁一个年龄组进行统计分析。结果男、女BMD峰值均分布在35～39岁年龄组。BMD随年龄增加逐渐下降,同龄男性BMD大于女性。OP患病率随年龄增加而上升。结论OP常见发病年龄在中年之后,呈进行性病变,在老年人更常见。     

双能X线吸收仪测定骨密度对骨质疏松症的诊断价值

目的:应用双能X线吸收仪(DEXA)测定腰椎L2～4前后位(anterior鄄post,A鄄P正位)和侧位的骨密度(BMD),以界定L2～4前后位和侧位男、女患者骨质疏松症(OP)的诊断临界值。方法:测定2115例患者L2～4的BMD,其中前后位1018例,侧位1097例。以T值≤-2.0s和≤-2.5s为诊断标准进行OP检出率分析。结果:按T值≤-2.0s、≤-2.5s计算,其中女性L2～4前后位的OP检出率分别为32.5%和14.5%,侧位分别为59.0%和33.4%;男性L2～4的前后位OP检出率分别为17.6%和6.4%,侧位分别为45.9%和17.8%。无论男女,以T值≤-2.0s为标准时,L2～4前后位与侧位的OP检出率差异显著(P<0.01)。L2～4前后位以T值≤-2.0s为标准的OP检出率和侧位以T值≤-2.5s为标准的OP检出率一致(P>0.05)。结论:男、女性L2～4前后位BMD测定可参考以T值≤-2.0s作为OP的诊断标准,侧位可参考以T值≤-2.5s作为诊断标准。     

骨超声衰减与双能X线吸收法测量骨密度的相关性研究

目的： 探讨跟骨宽带超声衰减诊断骨质疏松的临床价值。方法： 对一组５３ 例绝经期老年女性用超声衰减成像扫描仪测量左跟骨宽带超声衰减 （ＢＵＡ）, 并用双能Ｘ 线吸收法 （ＤＥＸＡ） 测量其腰椎Ｌ２－Ｌ４ 骨密度 （ＢＭ ＤＬ２－Ｌ４） 及右髋骨密度 （ＢＭ ＤＨ）, 将上述两种方法所测得的参数进行相关分析。结果： 左跟骨 ＢＵＡ 与腰椎ＢＭ Ｄ 呈中度相关 （ｒ＝ ０．６６１, Ｐ＜ ０．０００１）, 左跟骨ＢＵＡ 与右髋ＢＭ Ｄ 呈中度相关 （ｒ＝ ０．６１８, Ｐ＜ ０．０００１）, 左跟骨ＢＵＡ 与腰椎ＢＭ Ｄ、右髋ＢＭ Ｄ 诊断骨质疏松齐同率为８６．８％ 。结论： 跟骨ＢＵＡ 是评价骨密度的有效指标, 超声衰减成像技术是临床诊断骨质疏松的又一实用的新方法。     

两种双能X射线吸收法骨密度仪数据共享:Challenger与Holigic仪器的交叉校正

背景：为达到数据共享的目的,不同厂家生产的双能X射线吸收骨密度仪需要进行仪器之间的校正。目的：利用峰值骨量的人群尝试确立Challenger与Holigic QDR4500型DXA之间的数据换算关系。设计、时间及地点：数据直线相关及回归分析实验,于2007-10在青岛海慈医院骨密度室完成。对象：25～35岁符合青岛地区峰值骨密度的健康成年女性30人。方法：受试者分别经法国DMS公司产的Challenger型扇形束X射线吸收骨密度仪和美国Hologic公司产的QDR-4500A型扇形束X射线吸收骨密度仪测得骨密度值。主要观察指标：通过直线相关与回归分析分别计算出L2～4正位和左侧股骨颈、大转子、Ward三角区6个骨骼区域的骨密度换算公式,并进行青岛与长沙两地区健康女性多骨骼部位骨密度数据库校正前后的比较以验证公式的可行性。结果：两种骨密度仪测定得到的数据显著相关,存在线性关系。校正之前,青岛地区女性髋骨骨密度高于长沙地区;校正之后两地区骨密度无显著性差别。结论：峰值骨量人群可用于Challenger与Holigic QDR4500型双能X射线吸收骨密度仪之间的校正。     

超声骨密度测量仪临床应用价值研究

目的:探讨超声法诊断骨质疏松的临床应用价值。方法:采用随机、对照的临床试验方法,以随机编码的方式,对同一受试者先后利用试验仪器与对照仪器进行检查,对检测结果进行相关性和一致性分析。结果:1.超声骨密度仪与双能X射线骨密度仪所测参数T呈高度相关关系(r=0.84,P<0.01),线性回归方程为:T双能=1.1548T超声+0.7364;2.Bland-Altman一致性分析,两种方法测量参数T的超限率均为0,两仪器测量结果具有较高的一致性。结论:超声骨密度测量仪具有经济、安全、准确等优势,是一种值得推广应用的骨密度检测方法。     

双能X射线骨密度测定在骨质疏松诊治中的应用

双能X线骨密度测定（DXA）作为诊断骨质疏松重要手段之一,具有方便、快速、安全、无创、准确性和精确度好等优势,对骨质疏松的诊断、骨折风险估计、治疗选择方案、治疗监测等方面均有重要意义。     

支气管哮喘患者腰椎和股骨近端骨密度测量

目的 观察接受糖皮质激素（ＧＣ）治疗的支气管哮喘患者骨矿物质密度的变化。方法采用双能Ｘ线骨密度仪（ＤＥＸＡ）测量２６例接受ＧＣ治疗的支气管哮喘患者和年龄、性别匹配的２６例正常健康者的腰椎２～４（Ｌ_（２～４））和右侧近端股骨（股骨颈、大转子和Ｗａｒｄ’ｓ三角区）的骨密度（ＢＭＤ）。结果接受 ＧＣ治疗支气管哮喘患者 Ｌ_（２～４）、右侧股骨近端的 ＢＭＤ测量值（ｇ／Ｃｍ~２） 明显低于年龄和性别匹配的正常健康者,且与ＧＣ用药时间呈显著负相关。结论接受ＧＣ治疗支气管哮喘患者存在明显的骨质丢失,并与ＧＣ用药时间密切相关。     

不同性别Singh指数与双能X射线骨密度仪测量骨密度的相关性

背景:Singh指数和骨密度测量是临床常用来了解骨强度及骨质疏松情况的方法,而二者之间的相关性及其性别差异性未见报道.目的:了解Singh指数与双能X射线骨密度仪测量骨密度在不同性别的相关性.方法:取股骨颈骨折行假体置换患者股骨颈标本42份,将42份标本按性别分组采用双能X射线骨密度仪测量体外股骨颈骨密度值;对术前X射线片进行Singh指数分级,了解Singh指数与骨密度的双变骨量相关性.结果与结论:男性Singh指数与骨密度的双变骨量相关性分析结果显示,Spearman相关指数r=0.646,P=0.002,二者有非常显著的相关性,并且男性骨密度值与Singh指数有正相关性,根据二者的检查结果可初步判断患者骨质疏松情况;女性Singh指数与骨密度的双变骨量相关性分析结果显示,Spearman相关指数r=0.304,P<0.181,二者无统计学上的相关性,说明女性患者因绝经后骨质疏松加剧,骨密度值与Singh指数相关性不明确,临床治疗时需根据个体情况采用不同治疗方法.     

双能X线骨密度仪椎体骨密度测定骨质疏松症临床价值分析

目的:对骨质疏松症应用双能X线骨密度仪测定锥体骨密度的临床疗效展开分析。方法:选择我院2018年11月-2019年期间收治的80例骨质疏松患者作为研究对象,对所有患者均实施双能X线骨密度仪,测定不同年龄阶段椎体骨质疏松的情况。结果:不同年龄阶段骨质量测定的均值存在差异。根据骨密度的测定将其分为两个标准,骨密度≤x-2.0SD,骨密度≤x-2.5SD。经测定发现,所有患者的骨密度均不足x-2.0SD,其中65例骨密度不足。随着年龄的增长,骨质量均差的值越小。结论:对骨质疏松症应用双能X线骨密度仪测定锥体骨密度能够起到较高的临床应用价值,为临床治疗提供详细的数据,诊断价值较高。     

双能X线骨密度仪与定量CT测量骨密度的比较

骨质疏松必须有症状、体征、实验室检查(骨代谢生化和激素指标等)，X线片等方法的帮助，特异的定量的诊断骨质疏松的手段是骨密度测量，没有骨密度的支持是不能诊断骨质疏松。有创的骨组织形态计量法的手段难于在临床上推广，目前广泛应用的是各种无创性骨密度测量手段。故而临床中骨密度的测定目前主要是双能X线骨密度仪(dual-X-ray absorptiometry，DXA)与定量CT，但DCA与定量CT测量骨密度的争论由来已久。文章拟从两者的测量方式、原理及临床运用中遇到的问题作一综述。     

Bone mineral density measured by dual-energy X-ray absorptiometry in normal men

A cross-sectional study of 222 healthy Finnish men aged 20-69 years was performed to establish reference values of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DEXA). The effects of age, and of some physical and lifestyle factors on BMD of the lumbar spine and proximal femur (femoral neck, Ward's triangle and trochanter) were investigated. The maximal mean BMD was observed at the age of 20-29 years in all the measurement sites. Except for the trochanteric area, BMD diminished along with age, the over-all decrements being 4%, 11%, and 23% in the lumbar, femoral neck and Ward's triangle areas, respectively. BMD was in a positive relationship to weight and height in all the measurement sites. The adjusted (for age, height and weight) BMDs were higher (P less than 0.05) in the group of daily dietary calcium intake greater than 1200 mg as compared with the group of lowest calcium intake (less than 800 mg day-1) in the three femoral areas. Cigarette smoking or alcohol drinking had no obvious effect on BMD.     

Examination of femoral-neck structure using finite element model and bone mineral density using dual-energy X-ray absorptiometry

BackgroundResearch regarding femoral-neck fractures has mainly focused on bone mineral density and limited studies have been performed on relationship between the femoral-neck structure and its fracture.MethodsFinite element models were established to estimate stress distributions across the femoral neck with various femoral-neck angle from 115° to 140°. The bone mineral density measurements across the femoral-neck region using dual-energy X-ray absorptiometry were taken from 89 healthy and 10 patients with a femoral-neck fracture. Femoral neck angles were determined on radiographs from a separate group of participants.FindingsThe results showed that the bone mineral density of the fracture patients was significantly smaller in all examined areas around femoral neck, especially in the ward’s triangle. Under a same loading condition, the stress level may easily reach its intensity limit and therefore cause a fracture. The modeling results indicated that the posteromedial side of the femoral neck experienced the highest stress and was inversely related with the femoral-neck angle. As the angle decreased below 125°, the stress around the femoral neck increased significantly and therefore increases risk of fracture at the site.InterpretationsIt is recommended that if the femoral-neck angle is below 125° and is accompanied by low bone mineral density, the patient should be considered a high risk candidate for femoral-neck fracture. In addition, if the femoral-neck angle of one hip is significantly smaller than the other side and 125°, the hip should be also considered as high risk.     

双能X射线骨密度仪测量离体羊股骨骨折端及钢板对接骨折端的骨密度

背景:目前,羊已逐渐成为骨质疏松研究中很有前途的动物模型。目的:采用双能X射线骨密度仪测量羊股部骨折断端及全部骨密度,探讨双能X射线骨密度仪测量过程中的准确度和精确度。方法:对双能X射线骨密度仪自带的Lunar腰椎模型扫描10次/d,确定机器准确度,再连续扫描25d,根据所测数据建立Shewhart控制图。选取3只羊中5根股骨进行7次重复扫描,采用骨密度仪自带的小动物分析软件分析羊股部骨折断端的骨密度、全部的骨密度,计算其精密度。另外选取4只羊8根股骨,用2种钢板对骨折断端固定,分析骨密度及骨矿含量的变化。结果与结论:双能X线骨密度仪的准确度为-1.0%,离体羊股部骨折断端及全部的骨密度测量精密度为0.005～0.537g/cm2。股骨全部骨和骨折断端密度的短期精密度分别为0.8%和1.5%,股骨全部和骨折断端骨矿物含量的短期精密度为0.9%和7.5%。不同钢板固定后的羊股骨骨密度、骨矿含量差异无显著性意义。结果证实,双能X射线骨密度仪能准确测量离体羊股骨的骨密度,但在骨折断端骨矿含量精密度分析有一定的误差。     

双能X射线骨密度仪测量离体羊股骨骨折端及钢板对接骨折端的骨密度

背景：目前,羊已逐渐成为骨质疏松研究中很有前途的动物模型。目的：采用双能X射线骨密度仪测量羊股部骨折断端及全部骨密度,探讨双能X射线骨密度仪测量过程中的准确度和精确度。方法：对双能X射线骨密度仪自带的Lunar腰椎模型扫描10次/d,确定机器准确度,再连续扫描25d,根据所测数据建立Shewhart控制图。选取3只羊中5根股骨进行7次重复扫描,采用骨密度仪自带的小动物分析软件分析羊股部骨折断端的骨密度、全部的骨密度,计算其精密度。另外选取4只羊8根股骨,用2种钢板对骨折断端固定,分析骨密度及骨矿含量的变化。结果与结论：双能X线骨密度仪的准确度为-1.0%,离体羊股部骨折断端及全部的骨密度测量精密度为0.005～0.537g/cm2。股骨全部骨和骨折断端密度的短期精密度分别为0.8%和1.5%,股骨全部和骨折断端骨矿物含量的短期精密度为0.9%和7.5%。不同钢板固定后的羊股骨骨密度、骨矿含量差异无显著性意义。结果证实,双能X射线骨密度仪能准确测量离体羊股骨的骨密度,但在骨折断端骨矿含量精密度分析有一定的误差。     

双能X线骨密度仪在15 cm水深中测量骨密度的准确性

目的探讨双能X线骨密度仪(dual energy X-ray absorptiometry,DXA)测量骨密度的准确性.方法用DXA(前后位扫描)测量5具浸泡在15 cm水深中的猪腰段脊柱,共计20例椎骨,计算测量的结果与灰重及灰重密度相关性.结果骨矿含量与灰重呈显著正相关性(r=0.95,P＜0.01),而骨密度与灰重无明显相关性(r=0.41,P＞0.05).结论DXA测量骨密度中骨矿含量较准确,而骨密度较差.     

Comparison of dual-energy x-ray absorptiometry and dual photon absorptiometry for bone mineral measurements of the lumbar spine

A new x-ray-based (dual-energy x-ray absorptiometry [DEXA]) instrument for measurement of bone mineral in the spine and hips (QDR-1000, Hologic, Inc.) was compared with a commercial dual photon absorptiometry (DPA) instrument that uses a 153Gd source (DP3, Lunar Radiation Corporation). Measurements were made on phantoms and lumbar spines of patients to study accuracy, precision, limitations, and compatibility of results between instruments. Both instruments measure bone mineral of integral bone in terms of area bone density with an entrance exposure of less than 5 mR. For spinal bone mineral measurements, the DEXA instrument had a shorter scanning time and higher resolution images than the DPA system. The DEXA instrument also showed better precision in a spine phantom and reduced influence of thickness for patient measurement. For bone mineral content, accuracy was about equal for both instruments; for measurements of the area of the region of interest, accuracy was better with the DEXA instrument. With both instruments, fat had little effect on bone mineral density in bone phantom studies. Measurements on both instruments were influenced by the location of a bone phantom within the photon beam. Results in patients showed good correlation (r = 0.988) for bone mineral density. Measurements of bone mineral density in patients were consistently lower with the DEXA instrument because of better accuracy in area measurements. The new x-ray-based instrument is a major advance in bone mineral absorptiometry and provides improved, yet less expensive, measurements in research and clinical applications.     

基于双能X线吸收测量法的三种胫骨软骨下骨骨密度测量方法的信度与效度分析

目的 观察基于双能X线吸收测量法(DXA)的三种胫骨近端软骨下骨骨密度检测方法的信度与效度。方法 招募28名健康女性,利用双能X线骨密度仪扫描膝关节;由2名研究者分别应用三种不同测量方法选取ROI进行测量分析,通过计算组内相关系数值(ICC),评价各方法的复测信度与测量者间信度,利用t检验评价区分效度。结果 三种方法均具有较好的复测信度(ICC 0.833~0.998)与测量者间信度(ICC 0.905~0.997),且对低年龄者和高年龄者具有较好的区分效度(P<0.05)。结论 利用双能X线骨密度仪研究膝关节软骨下骨具有可行性;本研究分析的三种测量方法可有选择地用于临床研究。     

Correlation of quantitative heel ultrasonography with central dual-energy X-ray absorptiometric bone mineral density in postmenopausal women.

OBJECTIVES: In this study, we sought the proper cutoff level for quantitative ultrasonography (QUS) of the heel in identifying bone mineral density (BMD) categories as determined by dual-energy x-ray absorptiometry (DXA) in postmenopausal women. METHODS: With the use of DXA, BMD categories of the lumbar spine and different areas of the left femur of 420 healthy women according to World Health Organization definitions were determined. Quantitative ultrasonography of the heel was also performed in each subject. Receiver operating characteristic curves were plotted, and sensitivity and specificity of QUS to diagnose osteoporosis were examined at different points to identify the best cutoff level. The diagnostic agreement between the two techniques in identifying osteoporosis was assessed with kappa scores. RESULTS: The kappa scores were 0.31 for the lumbar region and 0.5 for the femoral neck region. On the receiver operating characteristic study, a score of -1 was found to be the appropriate cutoff point for QUS studies, in which the sensitivity of QUS to diagnose BMD osteoporosis varied between 78% and 87.5% depending on the site of the DXA study. With the proposed cutoff point (-1), sensitivity and specificity of QUS in detecting osteoporosis at the lumbar spine were 83.9% and 51%, respectively, and at the femoral neck were 84% and 50%, respectively. CONCLUSIONS: Insufficient agreement between QUS and DXA led to uncertainty on expected BMD in people tested by QUS. The proposed cutoff value could achieve higher sensitivity but only by accepting higher rates of false-positive results.     

超声骨密度检测早期儿童佝偻病的临床应用价值分析

【】目的：研究探讨超声骨密度检测法对诊断早期儿童佝偻病的临床应用价值,以期为早期儿童佝偻病的诊断提供新的方法。方法：选择2015年1月~2016年12月来本院就诊的160例儿童佝偻病患者和在本院进行体检的健康儿童100例为研究对象。分别编入观察组(n=160)和对照组(n=100),对两组儿童行超声骨密度检测。统计比较骨密度对早期儿童的佝偻病的诊断正确率;其次,对观察组和对照组儿童骨密度值进行比较分析;再者,对两组儿童的血钙、碱性磷酸酶浓度进行比较。结果：(1) 通过与佝偻病诊断金标准骨骼X射线检查法相比,超声骨密度检查法有着较高的诊断正确率,且表现为年龄越小诊断准确率越高;(2) 在各个年龄段观察组患者骨密度Z值均显著低于对照组儿童(P<0.05),且年龄越低与对照组间差异越大,观察组患者不同性别间骨密度Z值无显著性差异(P>0.05);(3) 观察组患者的血钙浓度低于对照组,碱性磷酸酶浓度则高于对照组,在观察组内血钙浓度随着骨密度的增加而增加,碱性磷酸酶浓度随着骨密度增加而降低。结论：通过超声骨密度的检查能够及早的对儿童佝偻病进行确诊,且有着很高的诊断准确率,是一种有效的临床诊断儿童佝偻病的新方法,并加以推广应用。