老年髋部骨折Singh指数的临床应用

目前：探讨Singh指数在骨质疏松性髋部骨折中临床应用价值。方法：取193例因低能量损伤致髋部骨折的骨盆X平片作Singh指数测定，按股骨近段骨质丢失程度由低到高分为Ⅶ度。结果：193例中有176例（91％）为Singh Ⅳ度以下。结论：Singh指数为一项方便、实用、特异性强的诊断骨质疏松症的指标，在临床应用中有一定意义。     

DXA椎体骨折评价在骨质疏松诊断中的意义

目的比较双能X线骨密度仪的椎体骨折评价(vertebral fracture assessment,VFA)中Genant半定量法和6点定量法对椎体压缩诊断的差异,探讨联合应用VFA在骨质疏松诊断中的意义。方法对85名主诉有腰背痛或身高变矮的患者行骨密度检查(男12例,女73例),平均年龄68.1±10.4岁;女性绝经年龄49.4±3.4岁。同时应用VFA软件分析椎体是否存在压缩,分别采用Genant半定量法和6点定量法进行分析。结果骨密度采用世界卫生组织(WHO)诊断标准,诊断骨质疏松66人,低骨量14人,5人骨量正常,骨质疏松诊断率为77.65%。采用Genant半定量法判断椎体Ⅰ~Ⅲ度压缩76人,6点定量法判断椎体压缩64人,两种方法的椎体压缩诊断率有差异(P0.01),两种方法的Ⅱ、Ⅲ度椎体压缩的诊断率无差异(P0.05)。6例通过骨密度T值诊断的非骨质疏松患者用VFA分析诊断有椎体骨折(压缩Ⅱ~Ⅲ度),应用T值联合VFA椎体压缩Ⅱ~Ⅲ度诊断的骨质疏松率为84.71%,与单独使用T值相比诊断率有差异(P0.05)。结论使用双能X线骨密度仪进行椎体骨折评价时,Genant半定量法和6点定量法对椎体压缩程度为Ⅱ、Ⅲ度的诊断率无差异、一致性好。骨密度检查时联合行VFA可增加骨质疏松的诊断率。     

评分分级法在胸腰椎爆裂骨折中的应用

目的：设计一种新的胸腰椎爆裂骨折分类方式－－评分分级法来判断病情、指导临床治疗、评定治疗效果及估计预后。方法：选择病人的X线片及CT片显示的椎管狭窄、椎体压缩、后凸畸形及脊髓损伤平面以下感觉运动情况作为评分的指标进行分级。采用此方法对109例胸腰椎爆裂骨折患者予以评分分级。Ⅰ级（0－6分）43例，采用非手术治疗；Ⅱ级（7－11分）47例，Ⅲ级（12－16分）19例，均分手术治疗组和非手术治疗组。结果：经治疗后，Ⅰ级患者神经损伤恢复有效率90％；Ⅱ、Ⅲ级患者椎体前缘压缩高度由术前49．5％恢复到术后94％，椎体后缘压缩高度由术前84％恢复到术后的97．5％。Ⅱ级患者手术组神经损伤恢复有效率93％，非手术组神经损伤恢复有效率60％；Ⅲ级病人手术组神经损伤恢复有效率60％，非手术组神经损伤恢复有效率33％。结论：评分分级法对胸腰椎爆裂骨折患者病情严重程度的判定、治疗方式的选择、治疗效果的评定及预后估计具有指导意义。     

骨质疏松症对老年股骨转子间骨折行动力髋螺钉内固定疗效的影响

目的 分析骨质疏松症对老年股骨转子间骨折行动力髋螺钉(DHS)内固定疗效的影响.方法 对28例合并有骨质疏松症的老年股骨转子间骨折患者行DHS内固定治疗,分析术后并发症和治疗效果.结果 获随访24例,失访4例,随访时间9 ～18个月.术后并发症:SinghⅣ级中髋内翻1例,SinghⅢ级中髋内翻2例,螺钉松动1例,螺钉切出头颈1例,下肢深静脉血栓1例;SinghⅡ级中螺钉松动1例,螺钉切出头颈1例.疗效按朱孟勇等评定方法:SinghⅤ级中优1例,良1例;SinghⅣ级中优2例,良3例,可1例;SinghⅢ级中优5例,良6例,可2例,差1例;SinghⅡ级中2例均为差.结论 合并骨质疏松症的老年股骨转子间骨折行DHS内固定治疗,骨质疏松程度越严重,术后并发症发生率越高,治疗效果优良率越低,对于SinghⅡ级及以下者不适宜行DHS内固定治疗.     

尿足细胞与狼疮肾炎关系的研究

目的研究尿足细胞与狼疮肾炎（ LN）的关系，探讨尿足细胞评估 LN 肾损伤的临床价值。方法选取20例行肾活检的LN患者，收集相关临床资料，光镜观察肾组织病理改变；电镜观察足细胞超微结构变化；免疫组化检测肾足细胞蛋白 Nephrin 的表达；免疫荧光技术检测 Podocalyxin 表达来计数尿足细胞数量。结果20例LN病理显示Ⅲ型2例、Ⅳ型12例、Ⅳ型＋Ⅴ型4例、Ⅴ型2例，足细胞标志蛋白Nephrin 表达较正常组明显减低，且Ⅳ型、Ⅴ型降低更明显。尿足细胞阳性检出率约80％，尿足细胞数量与肾
　　足细胞相关蛋白 Nephrin 的表达呈负相关（r＝－0．627， P ＜0．01），与狼疮活动性呈正相关（r＝0．571， P ＜0．05），与24h蛋白定量无明显相关性（r＝0．215， P ＞0．05）。结论尿足细胞数量可监测狼疮活动及肾小球损伤程度，为LN病理分型提供参考。     

骨质疏松性椎体骨折影像分型与椎体成形术疗效相关性分析

目的:探讨骨质疏松性椎体骨折影像类型与椎体成形术疗效的关系.方法:采用椎体成形术治疗骨质疏松性胸腰椎骨折348例.术前全部进行伤椎影像学检查(包括X光片、MRI及CT),按椎体骨折影像学形态改变将骨折病例分为5种类型(Ⅰ型:无变形型32例;Ⅱ型:单纯压缩型75例;Ⅲ型:伴非后缘崩裂型139例;Ⅳ型:伴后缘崩裂形65例;Ⅴ型 伴椎管轻度占位型37例).将五种型椎体骨折病例椎体成形术疗效进行比较分析.结果 随访6个月～12个月,5种类型中术后疗效以Ⅰ型疗效最佳,完全缓解(CR)率100%.Ⅱ型CR率94.67%,Ⅲ型CR率88.49%,Ⅳ型CR率86.15%,Ⅴ型CR率86.49%.疗效对比结果:除Ⅱ型与Ⅰ型之间对比结果差异无显著性外,其他类型与Ⅰ型对比结果差异均有显著性.骨水泥椎体外渗漏病例数除Ⅱ型与Ⅰ型之间对比结果差异无显著性外,其他类型与Ⅰ型对比结果差异均有显著性.结论:胸腰椎骨折影像诊断类型与椎体成形术疗效、风险直接相关,有重要临床意义.     

两种椎体成形术对老年骨质疏松症椎体压缩性骨折患者治疗效果的分析

目的探讨经皮椎体成形术和经皮椎体后凸成形术治疗老年骨质疏松症椎体压缩性骨折的效果。方法随机将92例老年骨质疏松症椎体压缩性骨折患者分成2组,各46例。对照组行经皮椎体成形术,观察组行经皮椎体后凸成形术。结果观察组下床活动时间、住院时间、患椎增加高度和骨水泥注射量均明显优于对照组,差异有统计学意义(P 0. 05)。2组治疗前的Cobb角、ODI指数、椎体压缩率、VAS评分差异无统计学意义(P 0. 05)。治疗后,观察组以上指标均明显优于对照组,差异有统计学意义(P 0. 05)。观察组术后并发症发生率低于对照组,差异有统计学意义(P 0. 05)。结论与经皮椎体成形术比较,经皮椎体后凸成形术治疗老年骨质疏松症椎体压缩性骨折,住院时间短、术后并发症少、椎体矫正效果好、缓解疼痛迅速,但需严格把握手术适应证。     

老年髋部骨折风险与Singh指数相关性研究

目的 探讨应用Singh指数预测老年人骨质疏松性骨折,并为发现高危人群提供简便廉效的方法.方法 本文统计了888例因受轻微外伤致股骨颈或粗隆间骨折患者的情况,拍骨盆正位片并用Singh六级分类法统计股骨上端骨小梁级数,并对骨折进行分型;运用SPSS软件探索不同性别、髋部不同骨折部位之间Singh指数分级差异;年龄、骨折分型与Singh指数的等级相关性等.结果 男性平均级数4.11±1.52,女性平均级数为3.08±1.40;股骨颈骨折患者为3.60±1.54,而粗隆间骨折的平均级数为3.12±1.43;两组数据经独立样本t检验均示P=0.000,具有非常显著的差异.Spearman等级相关分析显示:年龄与Singh指数具有非常显著地正相关性;而骨折分型方法中只有股骨颈骨折Garden分型与指数具有一定程度的负相关性.结论 Singh指数可作为有效的骨质疏松性髋部骨折风险评估的方法,尤其是对女性股骨颈骨折具有较大的预示意义;骨质疏松症是老年人髋部骨折的高危因素,其判断标准是股骨上端骨小梁级数下降男性低至Ⅳ级,女性低至Ⅲ级.     

原发性骨质疏松症并自发脊椎压缩性骨折的骨密度阈值探讨

作者收集１７６例４７～７６岁成都地区原发性骨质疏松症患者。采用美国ＤＰＸ－Ｌ型双能骨密度仪测量脊椎骨密度并摄胸腰椎侧位片，计算其楔形指数，结果表明自发脊椎压缩性骨折３８例，其Ｌ２～４骨密度显著低于非骨折组。对骨折组Ｌ２～４骨密度与椎体最小楔形指数用直线回归分析，对Ｔ５－Ｌ４所有≤０．８的楔形指数Ｌｏｇｉｓｔｉｃ回归分析，结果表明原发性骨质疏松症脊椎压缩骨折的骨折阈值的骨密度Ｌ２～４为０．８１２２ｇ／ｃｍ２。     

动力髋螺钉内固定与人工股骨头置换治疗高龄股骨转子间骨折短期疗效比较

目的 探讨动力髋螺钉(DHS)与人工股骨头置换(HA)治疗高龄转子间骨折的效果.方法 对行DHS内固定(90例)与HA(66例)的高龄顺转子间骨折患者临床资料进行回顾性研究,对比分析两组患者术后功能恢复及并发症情况.结合Tronzo-Evans骨折分型及Singh指数分级,探讨高龄转子间骨折治疗方式的选择.结果 对患者随访12～108个月.HA组较DHS组术后下地早,并发症发生率低,髋关节功能优良率高.在内固定失败率和假体松动率方面,HA组不仅在Ⅲ、Ⅳ型不稳定骨折和Singh指数在1～3级患者中明显低于DHS组,在Ⅰ、Ⅱ型稳定骨折和Singh指数在4～6级患者中亦明显低于DHS组(P<0.05).结论 HA治疗高龄顺转子间骨折短期疗效良好.结合Tronzo-Evans分型和Singh指数分级对高龄转子间骨折治疗具有指导意义,高龄转子间Ⅲ、Ⅳ型骨折首选HA治疗;对于严重骨质疏松Singh指数在1～3级的高龄患者,即使Ⅰ、Ⅱ型稳定骨折,也可首选HA治疗.     

Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients

To screen a potential risk factor for femoral neck fracture, we characterized lumbar vertebral fractures in 120 patients with femoral neck fractures (19 men, 101 women; mean age, 78.7 years) by investigating the frequency of patients with lumbar vertebral fracture, the number of vertebral fractures per patient, and the severity of deformity of the fractured vertebral bodies. These findings were compared with data gathered from a population of age- and sex-matched control patients (20 men, 89 women; mean age, 77.6 years) who had no evidence of femoral neck fracture. The heights of the anterior and posterior walls together with the midpart of the lumbar vertebrae were measured on lateral radiographs to identify fractures. The extent of height loss in the fractured vertebrae was calculated for each group. The incidence of patients with vertebral compression fractures was significantly higher in the femoral neck fracture group than in the control group (65.0% vs 41.1%). In terms of age, the difference in the incidence of vertebral fractures in the two groups was greater in the less aged (60–79 years old) than in the more aged (>80 years old) population. The mean number of lumbar vertebral fractures was also significantly greater in the femoral neck fracture group than in the control group (1.59 ± 1.39 vs 0.75 ± 1.19; P < 0.001). The incidence of more deformed vertebral fractures, which were defined as a vertebral height loss of more than 50%, was also significantly higher in the group with femoral neck fracture than in the control group (23.0% vs 7.3%). Based on these results, we concluded that multiple and more severely deformed vertebral fractures might represent a high risk for femoral neck fracture, particularly in patients less than 79 years of age. Care measures that encompass fall prevention and protection of proximal femurs in addition to drug therapy for osteoporosis should be recommended to individuals in this category. Received: Nov. 11, 1998 / Accepted: Jan. 13, 1999     

老年股骨颈骨折骨密度、Singh指数的研究

目的研究骨密度和Singh指数在衡量股骨近端骨强度和预测股骨颈骨折中的意义.方法对21名60岁以上、因轻度创伤所致新鲜股骨颈骨折老年人进行股骨近端骨密度、Singh指数及Ward三角矿化骨体积进行测量.结果本组患者股骨近端骨密度减少规律,Ward三角>股骨颈>股骨粗隆,骨密度减少的下限(±s)是股骨颈1.14SD、粗隆部0.35SD、Ward三角2.04SD;Singh指数4级以下(含4级)20名(95.2%);Singh指数与MBV呈正相关(r=0.517P<0.05),与粗隆部骨密度及减少的标准差呈正相关(r=0.457,0.474P<0.05).结论骨密度较峰值骨量减少的标准差数在股骨颈大于1.14、粗隆部大于0.35、Ward三角大于2.04,加上Singh指数低于4级(含4级)提示股骨颈骨折的危险性明显增高.     

Spontaneous subcapital femoral neck fracture complicating a healed intertrochanteric fracture

A spontaneous subcapital femoral neck fracture is an uncommon complication of a healed intertrochanteric hip fracture. To determine the etiology of this complication, 274 patients who had been treated for intertrochanteric hip fractures were followed up over an 8-year period from June 1988 to June 1996. We found 7 fractures of the subcapital femoral neck without a history of a trauma. The remaining 267 patients were defined as the control group. All seven patients with fractures of the subcapital femoral neck were women, and their average age at the time of compression hip screw (CHS) fixation was 83 years (range 74-92 years). The subcapital fractures occurred between 4 and 36 months after CHS fixation. The difference in the Singh index between the patient and control groups was statistically significant (P < 0.01). However, with regard to the position of the screw, spinal score, age, ambulatory ability, height, weight, and intertrochanteric fracture type (Jensen type), the differences between the patient and control groups were not statistically significant. Based on our findings, we conclude that a high grade of osteoporosis is the most important predisposing factor in the spontaneous development of a subcapital femoral neck fracture after a healed intertrochanteric hip fracture.     

围绝经期女性骨密度特点分析

目的总结并分析围绝经期女性腰椎1-4、股骨颈及髋关节部位的骨密度(bone mineral density,BMD)及其临床特点。方法收集2017年12月至2018年6月在我院住院部住院并进行双能X线吸收法骨密度检测的183例围绝经期女性,分别测定其腰椎1-4总体BMD、左侧股骨颈及左髋关节全部BMD,同时分析比较年龄、体质量指数(body mass index,BMI)与骨质疏松的关系。结果 183例患者中,检出骨质疏松39例(21. 3%),其中腰椎1-4、左股骨颈和左髋关节BMD各检出骨质疏松33例(18. 0%)、20例(10. 9%)、13例(7. 1%)。腰椎总体骨质情况与股骨颈、髋关节检查结果相符的各有129例(70. 5%)、119例(65. 0%),股骨颈总体骨质情况与髋关节检查结果相符的有137例(74. 9%)。在骨质疏松组、骨量减少组和骨量正常组,同一组病人腰椎1-4骨密度左髋关节骨密度左侧股骨颈骨密度,组间差异均有统计学意义。年龄、BMI与骨质疏松的发生均相关。骨质疏松与年龄呈正相关,与BMI、腰椎1-4总BMD、左股骨颈BMD、左髋关节BMD负相关,腰椎1-4 BMD与骨质疏松相关程度最高。结论腰椎整体骨密度呈现虚假升高趋势,腰椎1-4 BMD诊断骨质疏松的敏感性和特异性分别为84. 6%、100%,股骨颈分别为51. 3%、100%,髋关节分别为33. 3%、100%;年龄增长、BMI偏低会增加围绝经期妇女罹患骨质疏松的风险。     

Trabecular mineral contents of lumbar vertebra in patients with osteoporosis

The trabecular mineral contents (TMCs) of the third lumbar vertebra in normal subjects and patients with spinal osteoporosis and with femoral neck fracture were measured by quantitative computed tomography (QCT) using a reference phantom. The present paper describes these results. The TMCs in patients with spinal osteoporosis and with femoral neck fracture were significantly lower than those in normal subjects. When evaluated in terms of the ratio to the mean trabecular mineral content (mTMC) in normal subjects of the same decade groups, it was assumed that there should be a threshold value of vertebral compression fracture, and that value was approximately 50% of the mTMC in normal subjects. A correlation was noted between the data of the QCT method and those of the microdensitometric method in the groups with vertebral compression fracture and with femoral neck fracture, but not in the group without vertebral fracture.     

Classification of vertebral fractures

Although it is a cardinal feature of involutional osteoporosis, there is often disagreement on what constitutes a vertebral fracture. We measured vertebrae T4-L5 in 52 healthy women to develop a normal range (mean +/- 3 SD) for vertebral shape and used these data to assess the prevalence of vertebral fractures. We classified vertebral fractures by type of deformity (wedge, biconcavity, or compression) and further by the degree of deformity (grades 1 and 2). In 195 postmenopausal women who were an age-stratified random sample of the Rochester population (ages 47-94), 40 (21%) had vertebral fractures (mean, 2 per person). There was a similar number of compression and wedge fractures, and grade 2 fractures were as common as grade 1. In a referral sample of 74 women with suspected osteoporosis, 62 (84%) had vertebral fractures (mean, 3.3 per person). Wedge fractures were most common, and grade 2 fractures were more common than grade 1. The distribution of type and grade of fractures differed between the two patient groups (P less than 0.01). Bone mineral density of the lumbar spine was related to mean fracture grade (r = -0.33, P less than 0.05) and to fracture number (r = -0.57, P less than 0.001) but not to fracture type. We conclude that a comprehensive approach is required in describing vertebral fractures. Using this approach we found distortion in the fracture characteristics of women referred to an osteoporosis clinic compared to women in the community.     

老年性骨质疏松与髋部骨折

本研究采用随机分组设计比较了102名绝经后妇女中股骨颈骨折及股骨粗隆间骨折患者与正常对照组的Singh指数、股骨颈皮质骨指数和股骨外侧皮质骨厚度,结果表明两骨折组与正常对照组之间均有非常显著(P<0.01)或显著(P<0.05)之统计学差异,认为骨质疏松是老年人髋部骨折的主要影响因素之一,而采用X线平片评定股骨近端的骨量改变对于预测髋部骨折之危险性具有一定价值.     

The relationship of an Asian-specific screening tool for osteoporosis to vertebral deformity and osteoporosis

An Asian-specific screening tool for osteoporosis, the so-called OSTA index, was devised and is likely to be helpful in determining which postmenopausal women need bone mineral density (BMD) measurement. Besides BMD, prevalent vertebral fracture is a strong risk factor for future fractures. However, the relationship of the OSTA index to prevalent vertebral fractures is currently unknown. In this study, we evaluated the performance of the OSTA index in elderly Thai women and assessed the relationship of the index to prevalent vertebral deformities. Subjects consisted of 741 healthy Thai elderly women. BMD was measured by DEXA and T-score ≤2.5 SD is defined as osteoporosis. Prevalent vertebral deformities were determined by morphometric X-ray absorptiometry. OSTA index >−1 is classified as having low risk of osteoporosis, −1 to −4 as intermediate risk and, <−4 as high risk. Data were expressed as mean ± SD. The mean age and body weight of subjects were 67 ± 4.8 years and 57.8 ± 8.7 kg, respectively. The area under the ROC curve for OSTA index to identify osteoporosis at femoral neck and lumbar spine was 0.80 and 0.72, respectively. Femoral neck osteoporosis was found in 40.4%, 6.3%, and 2.4% of subjects with high-risk, intermediate-risk, and low-risk OSTA indexes, respectively. With regard to vertebral deformities, the area under the ROC curve relating OSTA index to vertebral deformities was 0.70 (P < 0.001). The prevalence of vertebral deformities in according to the OSTA index was 19.2% in the high-risk, 7.9% in the intermediate-risk, and 2.8% in the low-risk group. We concluded that the OSTA index can be of assistance in the selection of postmenopausal women for BMD measurement. In addition, this index may be helpful in the identification of postmenopausal women with vertebral deformity and those who need antifracture treatments.     

Singh指数与髋关节置换术后关节功能的相关性研究

目的 分析髋关节正位DR片Singh指数与髋关节置换术后关节功能间的相关性,评价Singh指数对髋关节置换术后功能的预测能力.方法 对2010年1月至2012年1月在山西医科大学第二医院行髋关节置换术的175例患者进行随访,分析患者术前髋关节正位DR片Singh指数与术后1年患者髋关节Harris评分的Spearman相关性.结果 共获得资料完整病例175例,男81例,女94例.其中骨关节炎病例28例,男12例,女16例;股骨颈骨折病例106例：男38例,女68例;股骨头坏死41例：男30例,女11例.股骨颈骨折患者Singh指数与Harris评分相关性较高（r=0.708,P〈0.01）,股骨头坏死患者Singh指数与Harris评分相关性较低（r=0.642,P〈0.01）,骨关节炎患者Singh指数与Harris评分相关性最低（r=0.541,P〈0.01）,均有统计学意义,男患者Singh指数与Harris评分相关性较女患者高,但差异没有统计学意义.结论 股骨颈骨折行人工股骨头置换术患者可根据股骨近端Singh指数预测术后关节功能状态,但对于股骨头坏死和髋关节骨性关节炎行全髋关节置换术患者Singh指数对术后关节功能预测能力相对较差.     

Experimental study on the mechanism of femoral neck fractures

To investigate the mechanism of femoral neck fracture, experimental studies were conducted on 48 femurs from 24 cadavers and the relationship between the type of fracture and loss of bone strength due to osteoporosis was investigated. The following results were obtained. 1) Intracapsular fracture was produced with the loading parallel to the axis of the femoral neck and with no applied rotatory force. 2) Among trochanteric fractures, peritrochanteric fracture was produced with rotatory force applied to the femoral head, while intertrochanteric fracture was produced with the loading perpendicular to the femoral shaft. 3) The fracture strength along the seven loading axes on the femoral head decreased with the progress of osteoporosis to the same degree in all directions. The fracture strength on Singh index Grade II, III examples decreased to approximately 1/3-1/4 of Grade VI examples. 4) The type of fracture macroscopically depended upon the direction of the loading, and had no correlation with osteoporosis.