强直性脊柱炎患者股骨密度与腰椎椎体骨折的相关性  

Association of femoral bone mineral density with lumbar vertebral fractures in patients with ankylosing spondylitis

作　　者：魏萌[1] 谢庆云[2] 杨晓平[1] 徐沪济[1] 

机构地区：[1]解放军第二军医大学长征医院风湿科,上海市200003 [2]解放军成都军区总医院骨科,四川省成都市610083

出　　处：《中国组织工程研究与临床康复》2009年第28期5575-5579,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:之前的观点认为强直性脊柱炎患者易发生椎体骨折是由于其继发性弥漫性的骨质疏松,而近年对强直性脊柱炎患者的骨矿物密度和椎体骨折的研究发现,两者之间并无相关性。文章旨在调查强直性脊柱炎患者腰椎椎体骨折与临床、实验室及影像学指标的相关性。方法:对65例强直性脊柱炎患者及62例健康体检者进行对比观察,每例受试者均拍摄腰椎平片判断有无椎体骨折,评估疾病活动性包括C-反应蛋白、血沉水平、指地距、Schober指数、Bath指数以及韧带骨赘评分,应用双能X射线吸收法测定腰椎及股骨骨密度。结果:65例强直性脊柱炎中有10例出现腰椎椎体骨折,占15.4%,其中楔形变4例,双凹畸形6例。强直性脊柱炎患者的腰椎和股骨骨密度均明显低于对照组(P<0.01)。有椎体骨折和无椎体骨折的强直性脊柱炎患者相比,其Schober指数、指地距、Bath指数、韧带骨赘评分以及转子间骨密度差异均有显著性意义(P<0.01)。多元Logistic回归分析发现,强直性脊柱炎患者转子间骨密度与腰椎椎体骨折的发生有独立相关性(P=0.041)。结论:强直性脊柱炎的股骨尤其是转子间低骨密度值与腰椎椎体骨折发生的危险性具有相关性。OBJECTIVE： Previous opinions consider the secondary diffuse osteoporosis as the very cause of vertebral fractures in patients with ankylosing spondylitis （AS）. However, recent studies on bone mineral density （BMD） and vertebral fractures in AS patients reveal that there is no relation between the two. This article aims at investigating the association of lumbar vertebral fractures with clinical, laboratory, and imaging indexes in AS patients. METHODS： A contrast observation was performed between 65 AS patients and 62 healthy physical examinees, whose lumbar vertebral plain radiographs were taken for checking vertebral fractures. Disease activity evaluation indexes included C-reactive protein, erythrocyte sedimentation rate, finger-to-ground distance, Schober＇s index score, Bath AS radiology index （BASRI） and syndesmophyte score. Dual energy X-ray absorptiometry technique was used to measure BMD levels of lumbar vertebras and femurs. RESULTS： Out of the total 65 AS patients, 10 ones （15.4%） had lumbar vertebral fractures, with 4 ones with wedge deformities and the other 6 ones with biconcave deformities. BMD levels of Lumbar vertebras and femurs in AS patients were significantly lower than those in controls （P 〈 0.01）. There were significant differences in Schober＇s Index scores, finger-to-ground distance scores, Bath scores, syndesmophyte scores and intertrochanter BMD values between AS patients with and without vertebral fractures （P〈 0.01）. Multiple logistic regression analyses revealed that intertrochanter BMD values were independently associated with lumbar vertebral fractures in AS patients （P =0.043）. CONCLUSION： There is a correlation between low femoral BMD levels and the risk of lumbar vertebral fractures in patients with AS, especially at the intertrochanter area.

关 键 词：强直性脊柱炎 骨质疏松 股骨 骨密度 椎体骨折 

分 类 号：R681.51[医药卫生—骨科学]