脑卒中偏瘫患者继发骨质疏松症的特点

背景脑卒中及脑损伤所致偏瘫后易造成继发性骨质疏松,其骨密度值和骨矿含量是预测骨质疏松骨折的危险性的有效参数.目的通过对偏瘫患者骨密度值及骨矿含量的测定与分析,探讨偏瘫患者骨质疏松发生的特点.设计病例分析.对象选择1999-03/2002-05在北京博爱医院神经康复科住院的偏瘫患者156例.男87例,女69例;年龄17～65岁,平均年龄(47.0±5.3)岁;病程19 d～1年,平均病程(5.0±3.5)个月;疾病类型脑梗死89例,脑出血67例;瘫痪侧别左侧79例,右侧77例.方法所有患者使用LUNAR双能X射线骨密度仪从头部至足部进行全身扫描,测量骨密度和骨矿含量.主要观察指标①不同病程偏瘫患者中骨质疏松发生率.②不同部位瘫痪患者的骨矿含量.结果156例患者全部进入结果分析.①病程在3～6个月骨质疏松发生率最高(44%,16/36),病程在9～12个月骨质疏松发生率最低(21%,7/33),总体骨质疏松发生率为31%(48/156).②病程在3个月内47例患者中有9例为弛缓性瘫,均患有骨质疏松,其中2例发生骨折.病程3～6个月36例患者中有3例为弛缓性瘫,也患有骨质疏松.③上肢患侧的骨矿含量明显低于健侧[(154.76±43.91)g,(172.59±43.78)g,(t=3.591,P＜0.001)].下肢患侧的骨矿含量与健侧基本接近[(463.41±309.28)g,(464.11±86.45)g,(t=0.027,P＞0.05)].结论偏瘫患者的骨量变化随偏瘫时间的不同有不同的变化.上肢患侧的骨矿含量低,下肢患侧骨矿含量接近正常,这是由于下肢较早的进行功能锻炼,说明骨量的大小与运动有密切关系.

Characteristics of secondary osteoporosis in stroke patients with hemiplegia

BACKGROUND: Hemiplegia caused by stroke or brain injury may lead to secondary osteoporosis. Under the circumstance, bone mineral density (BMD) and Bone Mineral Content (BMC) are two effective factors for predicting the risk of osteoporosis-related fracture OBJECTIVE: To investigate the characteristics of secondary osteoporosis in stroke patients with hemiplegia by measuring and analyzing BMD and BMC.DESIGN: A case study.PARTICIPANTS: From March 1999 to May 2002, 156 hemiplegia patients at the Neurorehabilitation Department of Peking Boai Hospital were selected, 87 males and 69 females, with an age ranging from 17 to 65 years old, in average of (47.0±5.3) years old and having a course of diseases ranging (5.0±3.5) months. The types of their illness: 89 had cerebral infarction, 67 had cerebral hemorrhage. Hemiplegia sides: 79 patients had hemiplegia in the left and 77 in the right.METHODS: Using LUNAR Dual Energy X-Ray densitometers, all the patients underwent a fro-top-to-toe scan to assess the BMD and BMC status.MAIN OUTCOME MEASURES: ① The occurrence rate of osteoporosis in patients with various course of hemiplegia. ② The BMC in patients with hemiplegia in various part.RESULTS: All the 156 patients entered the statistical analysis procedure.① The occurrence rate of osteoporosis was highest in patients with 3 to 6 months of hemiplegia (44%, 16/36) and was lowest in those with 9 to 12 months of disease (21%,7/33). The total occurrence rate of osteoporosis was 31% (48/156). ② For those with a less-than-3-month course of hemiplegia: Of all the 47 patients, 9 had dystonic hemiplegia, all suffering from osteoporosis and 2 of whom having fracture. For those with a 3-to-6-month course of hemiplegia: Of all the 36 patients, 3 had dystonic hemiplegia and osteporosis as well. ③ BMC in the affect side of upper limb was signifi cantly lower than that in healthy side [(154.76±43.91) g, (172.59±43.78) g,t=3.591, P＜ 0.001]. BMC in the affect side of lower extremity was close to that in healthy side [(463.41±30928) g, (464.11±86.45) g, t=0.027, P＞ 0.05].CONCLUSION: In patients with hemiplegia, changes in bone mass fluctuate with the length of hemiplegia. BMC in the affect side of upper limb is low while that in the healthy side is nearly normal. It may be explained that upper extremities start the functional exercises at an early time. This indicated that bone mass has a close relationship with excercises.