股骨上端几何结构和骨密度与骨质疏松性髋部骨折的关系

Relationship of femoral bone mineral density and geometry of the upper femur with hip osteoporotic fracture

目的:通过股骨上端几何结构和骨密度的分析,了解其与骨质疏松性髋部骨折的关系。方法:选择2002-03/2004-04解放军广州军区广州总医院髋部骨折骨质疏松的患者47例。另选择门诊健康查体的老年人50例为对照组。用双能X线骨密度测量仪检测股骨颈、Ward’s三角和转子处骨密度。所有受试对象均拍摄包括股骨上段在内的X线骨盆平片,测量股骨颈轴长及颈干角,同一平面股骨上端骨皮质厚度,并测定Singh指数。结果:参与者均进入结果分析。①股骨近端3个部位骨密度:骨折组股骨颈骨密度和Ward三角区骨密度低于对照组,差异有显著性(P<0.05)。而转子处骨密度两组对比差异无显著性(P>0.05)。②股骨上端几何结构测量数据:骨折组颈干角和股骨颈轴长均大于对照组,差异有显著性(P<0.05)。骨折组同一平面股骨上端骨皮质厚度小于对照组,差异有显著性(P<0.05)。③Singh指数Ⅲ度以下人数所占百分比:骨折组的Singh指数Ⅲ度以下占83%,对照组为54%,两组之间差异有显著性(P<0.05)。结论:髋部骨密度、股骨上端几何结构结合Singh指数可以提高对髋部骨质疏松骨折危险性的预测。

AIM： To investigate the relationship of osteoporotic hip fracture with femoral neck bone mineral density （BMD） and proximal femur geometry （PFG） by analyzing the data of BMD and PFG. METHODS： Forty-seven patients with osteoporotic hip fracture （fracture group）, who were treated in General Hospital of Guangzhou Military Area Command of Chinese PLA between March 2002 and April 2004. Meanwhile, 50 elderly healthy physical examinees in the same hospital were selected as control. Femoral neck BMD （FEBMD）, Ward＇s BMD （WABMD） and trochanter BMD （TRBMD） were measured by dual energy X-ray absorptiometry （DEXA）. Femoral neck axis length （FNAL）, neck shaft angle （NSA） and cortical thickness of proximal femur were measured by plain pelvis radiography including upper femur, while Singh index was assessed. RESULTS： All subjects were involved in the result analysis. ①FEBMD and WABMD of fracture group were significantly lower than that in controls （P 〈 0.05）, while there was no significant difference in TRBMD between two groups （P 〉 0.05）. ②FNAL and NSA of fracture group were remarkably bigger than that in controls （P 〈 0.05）, and the cortical thickness of proximal femur was significantly lower than that in controls （P 〈 0.05）. ③Percentage of cases of Singh index below Ⅲ° in fracture group was 83.0% and 54.0% in controls. There were significant differences （P 〈 0.05）. CONCLUSION： Hip BMD, Singh index combined with geometry of upper femur may be used to predict the occurrence of hip fracture in elderly persons.