桡骨远端骨皮质厚度与骨密度的相关性  

Correlation between distal radial cortical bone thickness and bone mineral density

作　　者：叶春晓[1] 郭颖彬[1] 吴振斌 林南杰 郑尤辉 陈开宇[1] 张小玲[1] 肖良秀 YE Chun-xiao;GUO Ying-bin;WU Zhen-bin;LIN Nan-jie;ZHENG You-hui;CHEN Kai-yu;ZHANG Xiao-ling;XIAO Liang-xiu(Upper Extremity Service,Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University,Quanzhou 362000,Fujian,China)

机构地区：[1]福建中医药大学附属泉州市正骨医院上肢科

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2019年第3期240-247,共8页Chinese Journal Of Osteoporosis And Bone Mineral Research

摘　　要：目的 探讨伤后腕关节正位X线影像测量桡骨远端骨皮质厚度的可行性、桡骨远端骨皮质厚度与髋部及腰椎骨密度之间的关系以及评估桡骨远端骨皮质厚度预测骨质疏松症的能力。方法 对91例年龄≥50岁经X线确诊为桡骨远端骨折的患者行双能X线吸收检测法(dual energy X-ray absorptiometry,DXA)测定,根据 T 值分为两组:骨质疏松组55例,男性6例,女性49例,年龄52~83(63.5±8.2)岁,体质量 46~ 88(57.2±8.1)kg,体质量指数(body mass index,BMI)(24.3±3.0)kg/m^2;非骨质疏松组36例,男性2例,女性34例,年龄50~69(57.9±6.1)岁,体质量42.5~80.0(62.5±8.7)kg, BMI(25.5±3.3)kg/m^2。通过医学影像信息系统(picture archiving and communication systems,PACS),在腕关节正位X线影像上,于距离尺骨远端关节面40、60 mm处测量桡骨远端双侧骨皮质厚度。结果 骨质疏松组患者较非骨质疏松组年龄大、体质量轻,且桡骨远端骨皮质厚度较非骨质疏松组薄,骨皮质比率较非骨质疏松组低,差异有统计学意义( P <0.01);两组患者BMI差异无统计学意义( P >0.01)。桡骨远端骨皮质厚度与髋部骨密度正相关( r = 0.309, P =0.000),与腰椎骨密度正相关( r =0.445, P =0.000)。一元线性回归分析表明:桡骨远端骨皮质厚度每增加 1 mm ,髋部骨密度值增加0.071 g/cm^2( R^2=0.230, P =0.000),腰椎骨密度值增加0.065 g/cm^2 ( R^2= 0.265, P =0.000)。桡骨远端骨皮质厚度5.2 mm为诊断骨质疏松最佳诊断临界点,其敏感度80.4%、特异度69.4%、阴性预测值69.4%,曲线下面积为0.749。结论 桡骨远端骨皮质厚度与髋部及腰椎骨密度正相关,桡骨远端骨皮质变薄与骨质疏松相关,通过X线检查测量桡骨远端骨皮质厚度快速简便,可初步筛查骨量减少,并提示进一步行骨密度检查。Objective To determine interobserver reliability in measuring the cortical thickness of distal radiuses at the time of injury and to determine whether there is a correlation between distal radius cortical thickness and hip and lumbar bone mineral density on dual-energy X-ray absorptiometry (DXA).The study also assesses the discriminative capability of cortical bone thickness measurements at the distal radius to differentiate patients with osteoporosis. Methods The BMD of the pronimal hip and lumbar spine were measured in 91 patients with distal radius fractures(≥50 years old).Patients were categorized as non-osteoporotic or osteoporotic group according DXA T -score. There were 36 patients in non-osteoporotic group, including 2 males and 34 females [age 50-69 years,mean (57.9±6.1)years;weight 42.5-80.0 kg,mean (62.5± 8.7)kg;body mass index(BMI)(25.5± 3.3)kg/m^2 ].There were 55 patients in osteoporotic group including 6 males and 49 females [age 52-83 years,mean (63.5±8.2)years;weight 46-88 kg,mean (57.2±8.1)kg;BMI(24.3±3.0)kg/m^2].Radial bicortical widths were measured at 40 mm and 60 mm proximal to the distal ulnar articular surface, and mean bicortical thickness of the distal radius(DRCT)was calculated from radiographs of the injured wrist which were downloaded from picture archiving and communications system. Results The age of osteoporotic group was higher than that of non-osteoporotic group,the weight was lower, the distal radial cortical thickness was thinner and the cortex ratio was smaller in osteoporotic group than that of non-osteoporotic group(all P <0.01). The BMI score had no statistical difference between the two groups. Bicortical thickness of the distal radius was positively correlated with femoral bone mineral density(BMD)( r =0.309, P =0.000),and lumbar BMD( r =0.445, P =0.000);1 mm increase in average bicortical thickness was associated with a 0.071 g/cm^2-increase in femoral BMD( R^2=0.230, P =0.000),a 0.065 g/cm^2 increase in lumbar BMD( R^2=0.265, P =0.000).An DRCT of 5.2 mm was selec

关 键 词：桡骨远端 骨皮质厚度 骨质疏松 骨密度 脆性骨折 

分 类 号：R681[医药卫生—骨科学]