肩袖撕裂患者肱骨近端骨密度检测及对术中锚钉拔出风险预测  

Measurement of proximal humeral bone mineral density in patients with rotator cuff tear and its prediction of intraoperative anchor loosening risk

作　　者：谈绎文[1] 郑昱新[1] 王学宗[1] 顾新丰[1] TAN Yiwen;ZHENG Yuxin;WANG Xuezong;GU Xinfeng(Department of Bone and Joint,Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)

机构地区：[1]上海中医药大学附属曙光医院骨关节科,200021

出　　处：《国际骨科学杂志》2022年第3期167-171,共5页International Journal of Orthopaedics

摘　　要：目的通过特殊部位双能X线吸收检测法(DXA)测量肩袖撕裂患者术前患肩肱骨近端不同区域骨密度,探讨其影响因素及对术中锚钉松动预测的可能性。方法选取自2019年5月至2021年8月诊治的52例肩袖撕裂患者,记录性别、年龄、身高、体质量、病程等临床资料,术前标准DXA检测腰椎及髋部的骨密度得出正常、低骨量、骨质疏松的诊断。使用特定体位DXA测量患侧肱骨近端5个区域的骨密度。行关节镜下使用缝线锚钉的肩袖修复术,比较术中锚钉松动和未松动病例的肱骨大结节近端骨密度。结果肩袖撕裂患者肱骨近端不同区域骨密度值如下:肱骨头中央区(Ce)(0.667±0.294)g/cm^(2)、大结节近端区(Gp)(0.563±0.241)g/cm^(2)、大结节远端区(Gd)(0.401±0.227)g/cm^(2)、小结节近端区(Lp)(0.562±0.274)g/cm^(2)、小结节远端区(Ld)(0.425±0.250)g/cm^(2)。骨密度值除了Gp与Lp、Gd与Ld之间无明显差异外,余各组之间均有明显差异,骨密度值肱骨头中央区>大、小结节近端区>大、小结节远端区。Gp区的骨密度:男性(15例)为(0.724±0.110)g/cm^(2),女性(37例)为(0.498±0.250)g/cm^(2),男性大于女性(P<0.01);正常组高于骨质疏松组(P<0.05);其与年龄无明显相关(P>0.05)。术中3例患者出现锚钉松动,其Gp区骨密度为(0.249±0.149)g/cm^(2),低于未松动者Gp区骨密度[(0.582±0.233)g/cm^(2),P<0.05]。结论DXA能对肩袖撕裂患者肱骨近端骨密度进行评估,肱骨大结节近端足印区骨密度在女性及骨质疏松症患者中较低,其可用来预测术中锚钉松动的可能。Objective To measure the bone mineral density(BMD)of different areas of the proximal humerus in patients with a rotator cuff tear by dual energy X-ray absorptiometry(DXA)at specific sites,and discuss its influencing factors and the possibility of predicting anchor loosening during surgery.Methods Fifty-two cases of rotator cuff tear from May 2019 to August 2021 were selected.Clinical data comprising gender,age,height,weight and course of disease were recorded.The BMD at the lumbar spine and hip were measured by standard DXA preoperatively to obtain a diagnosis of normal,osteopenia or osteoporosis.The BMD of five areas of the proximal humerus of the affected side was measured by DXA in specific postures and arthroscopic rotator cuff repair with suture anchor was performed,and the BMD of the proximal greater tubercle of the humerus in cases with and without loosening were compared.Results The mean BMD of different areas of the proximal humerus in patients with rotator cuff tear were central area of the humeral head(0.667±0.294)g/cm^(2),proximal area of the greater tuberosity(0.563±0.241)g/cm^(2),distal area of the greater tuberosity(0.401±0.227)g/cm^(2),proximal area of the lesser tuberosity(0.562±0.274)g/cm^(2),and distal area of the lesser tuberosity(0.425±0.250)g/cm^(2).No significant differences were found between the proximal and distal areas of the greater tuberosity,or proximal and distal areas of the lesser tuberosity,but there were significant differences among all the other groups.BMD values:central area of the humeral head>proximal area of the greater or lesser tuberosity>distal area of the greater or lesser tuberosity.For the proximal area of the humeral greater tubercle,the BMD of 15 males[(0.724±0.110)g/cm^(2)]was greater than that of 37 females[(0.498±0.250)g/cm^(2),P<0.01];the normal group was higher than the osteoporosis group(P<0.05);and there was no significant correlation with age(P>0.05).During the operation,the anchors became loose in three cases,the BMD in the proximal area of the grea

关 键 词：肩袖撕裂 骨质疏松 骨密度 双能X线吸收检测法 肱骨大结节 

分 类 号：R687.4[医药卫生—骨科学]