定量CT对老年髋部骨折患者的股骨近端形态结构研究

 目的  利用定量CT(quantitative CT,QCT)比较股骨颈骨折及股骨粗隆间骨折在股骨近端几何结构参数上的差异,从而更好地进行髋部骨折的风险预测。方法  对93例因髋部骨折收治入院的患者行QCT扫描测量健侧髋部骨密度及进行髋部几何结构分析。患者年龄70～96岁,平均年龄(82.31±7.76)岁,男性21例,女性72例;股骨粗隆间骨折31例,股骨颈骨折62例。分析髋部几何结构参数包括股骨颈区域的最小横截面积(minimum cross-sectional area,CSA)、横截面转动惯量(cross-sectional moment of inertia,CSMI)、截面模量Z值(cross-sectional modulus Z,Z score)、屈曲比率(buckling ratio,BR)、皮质骨厚度(cortical bone thickness,CTh) 以及髋关节轴线长度(hip axis length,HAL)。结果  QCT所测两种髋部骨折在髋部各区域骨密度差异无统计学意义。发现股骨颈骨折组的CSA小于粗隆间骨折组(P<0.05);而股骨颈骨折组的HAL大于粗隆间骨折组(P<0.05);股骨颈骨折组在股骨颈前上象限的CTh小于粗隆间骨折组(P<0.05)。结论  股骨颈CSA较小、HAL较长、CTh较薄的老年人群跌倒后更容易造成股骨颈骨折。

Quantitative CT research on the proximal femur morphologyof patients with hip fracture

Objective  To better predict the risks of hip fracture by contrasting the differences of proximal femur geometry parameter between femoral neck fracture and intertrochanteric fracture with quantitative CT (QCT).Methods  QCT were performed on 93 patients with hip fractures to measure the bone mineral density (BMD) of hip and to analyze hip geometry of unaffected side.The patients consisted of 21 males and 72 females,aged from 70 to 96 years old with an average age of (82.31±7.76) years old;31 of them were referred for intertrochanteric fracture and 62 for femoral neck fracture.Hip structure analysis (HSA) parameters included minimum cross-sectional area (CSA),cross-sectional moment of inertia (CSMI),cross-sectional modulus Z (Z score),buckling ratio (BR),cortical bone thickness (CTh) and hip axis length (HAL).Results  For the two types of hip fractures measured by QCT in each proximal femur area,there was no statistical difference in th BMD (P>0.05).The CSA of femoral neck fracture group was smaller than that of intertrochanteric fracture group (P<0.05).The HAL of femoral neck fracture group was larger than that of intertrochanteric fracture group (P<0.05).The CTh in the superoanterior quadrant of femoral neck fracture group was smaller than  that of intertrochanteric fracture group (P<0.05).Conclusions  Aged people with small minimal CSA of femoral neck,long HAL and low CTh have a greater tendency for femoral neck fracture after falling down.