髋部骨密度与合并帕金森病老年髋部骨折类型的关系

Relationship between bone mineral density and hip fracture type in patients with Parkinson disease

目的 探讨合并帕金森病（PD）的老年患者髋部骨密度（BMD）与跌倒所致髋部骨折类型之间的关系. 方法 2010年1月至2014年4月共收治43例合并PD的老年髋部骨折患者,男14例,女29例;平均年龄为（79.3 ± 11.4）岁;体质量指数平均为（21.9±3.9） kg/m2;PD病程平均为（5.4±4.8）年;骨折类型：股骨颈骨折26例,股骨转子间骨折17例.比较股骨颈骨折患者与股骨转子间骨折患者5个区域（股骨颈、转子、转子间、整髋、Ward区）的BMD,再采用多因素logistic回归分析探讨髋部不同区域BMD与髋部骨折类型之间的关系. 结果 股骨颈骨折患者在转子、转子间、整髋的BMD[（0.636±0.147）、（0.751 ±0.113）、（0.787±0.139） g/m2]均高于股骨转子间骨折患者[（0.573 ±0.125）、（0.602 ±0.127）、（0.672±0.121） g/m2],差异有统计学意义（P＜0.05）,而股骨颈骨折患者与股骨转子间骨折患者股骨颈、Ward区的BMD比较差异均无统计学意义（P＞0.05）.多因素logistic回归分析结果显示：在转子、转子间、整髋3个区域的BMD与髋部骨折类型存在统计学关联（P＜0.05）.转子、转子间、整髋的BMD每增加1个单位,股骨转子间骨折的发生风险分别降低为股骨颈骨折的0.21、0.37、0.36. 结论 合并PD老年患者的股骨颈骨折在髋部3个区域（转子、转子间、整髋）的BMD显著高于股骨转子间骨折.

Objective To investigate the association between bone mineral density （BMD） and hip fracture type in patients with Parkinson disease（PD）.Methods From January 2010 through April 2014,43 patients with PD were treated at our department for hip fractures.They were 14 males and 29 females,with an average age of 79.3 ± 11.4 years and an average BMD of 21.9 ±3.9 kg/m2.Their PD course averaged 5.4 ±4.8 years.Of them,26 had femoral neck fracture and 17 femoral intertrochanteric fracture.The BMDs at 5 regions （neck,trochanter,inter-trochanter,whole hip and Ward） were compared between femoral neck fractures and femoral intertrochanteric fractures.Multinomial logistic regression was conducted to analyze the correlation between BMD and hip fracture type.Results The BMDs at the regions of trochanter,inter-trochanter and whole hip in femoral neck fractures （0.636± 0.147 g/m2,0.751 ± 0.113 g/m2 and 0.787 ± 0.139 g/m2） were significantly higher than those in femoral intertrochanteric fractures （0.573 ± 0.125 g/m2,0.602 ±0.127 g/m2 and 0.672 ±0.121 g/m2） （P 〈 0.05）.There were no significant differences regarding the BMDs at the regions of neck and Ward between femoral neck fractures and femoral intertrochanteric fractures （P 〉 0.05）.Logistic regression analysis showed that the BMDs at the regions of trochanter,inter-trochanter and whole hip were associated with the fracture type （P 〈 0.05）.An increase of one unit of BMD at the regions of trochanter,inter-trochanter and whole hip caused the risk of femoral intertrochanteric fracture to decrease to 0.21,0.37 and 0.36 of that of femoral neck fracture.Conclusion For patients with PD,the BMDs at the regions of trochanter,inter-trochanter and whole hip in femoral neck fractures are remarkably higher than those in femoral intertrochanteric fractures.