腰椎侧位骨密度测定的应用价值研究

Study on the Application Value of Determination of Bone Mineral Density by Lateral View of Lumbar Spinal Vertebrae Using DEXA Method

目的 :观察应用双能X线测定腰椎椎体骨密度时正位和侧位结果的差别 ,探讨腰椎侧位测定骨密度辅助诊断骨质疏松症的价值。方法 :以 16 6名平均年龄为 6 4 .7岁的老年女性骨质疏松症患者为对象 ,测试其腰椎骨密度值 ,观察不同年龄受试者腰椎正、侧位骨密度的差别 ,以及由此测试结果得到的诊断骨质疏松结论的差别。结果 :全部受试者的椎体正位骨密度检测均高于侧位(P <0 0 1) ,但在 113名年龄小于 6 5岁的受试者中 ,以此诊断骨质疏松症的结果并无显著性差异(P >0 0 5 ) ;5 3名年龄大于 6 5岁的受试者中 ,根据正、侧位骨密度的变化得到的骨质疏松症诊断出现较大偏差 (P <0 0 5 )。根据正位骨密度测定诊断骨质疏松症约有三分之一漏诊率。结论 :对绝经期骨质疏松患者可以用传统的正位腰椎骨密度测定的方法来诊断 ,不需另作侧位测定 ,对老年性骨质疏松症患者 ,则应加作腰椎侧位骨密度测定 。

Purpose To identify the value of determination of bone mineral density (BMD) by lateral view of lumbar spinal vertebrae comparing to the traditional anterior-posterior (AP) view using dual energy X-ray absorptiometry (DEXA). Methods 166 female patients (average age 64.7 year-old) were undertaken AP and lateral view examination of lumbar spinal vertebrae for BMD, the differences of BMD and the rate of osteoporosis by the two views were compared in different age groups. Results All examination showed that the BMD was higher in AP view than lateral view (P< 0.01). For the 113 out of 166 patients whose age were under 65, the osteoporosis rates judged by BMD from the two views were similar (P<0.05); however, for the 53 remaining patients whose age were above 65, the osteoporosis rate was different in AP view and lateral view (P < 0.05). About one third of osteoporosis patients were mis-diagnosed as osteopenia by the results of AP view. Conclusion For post menopause osteoporatic patients, traditional AP view method for BMD is enough, it is not necessary to do the lateral view. However, for aged osteoporatic patients, lateral view of lumber spinal vertebrae for BMD using DEXA is definitively needed in order to avoid mis-diagnosis.