Ward三角区再研究

Further study on the Ward's triangle region

目的深入研究Ward三角区骨密度的临床意义。方法采用美国Norland XR-600双能X线骨密度仪,通过测定1189例病人的左股骨近端骨密度,评估计算机自动生成的Ward三角区的特点;通过测定30例志愿者左右股骨近端骨密度,评估不同肢体侧别的骨密度是否存在差异;通过对72例随访病人3~6月内进行左股骨近端骨密度测定,观察Ward三角区骨密度在较短时间内随时间的变化规律及临床特点。结果 1Ward三角区由计算机根据骨密度最低值自动搜索形成,大部分受试者（86.7%）Ward三角区位于股骨颈底边附近,少部分受试者（5.2%）位于股骨颈外,以大粗隆最为常见,与解剖位置不完全对应;2部分受试者（8.7%）Ward三角区骨密度并非股骨上段最低值,最低值出现在大粗隆。3计算机自动生成的Ward三角区小方块前后两次位置无明显变化。4Ward三角区骨密度值的精确度误差（2.27%）大于股骨颈（1.05%）及大粗隆（1.57%）。5正常人双髋骨密度无显著性差异（P=0.32,P〉0.05）。672例随访患者Ward三角区的骨密度（BMD）变化先于股骨颈及正位腰椎出现。结论髋关节采用标准体位摆放,Ward三角区位置较为固定,可用于临床随访。

Objective To study the clinical significance of bone mineral density（ BMD） in the Ward＇s triangle region. Methods BMD of the left hip was measured in 1189 patients with dual-energy X-ray absorptiometry（ DXA,Norland XR-600） to evaluate the characteristics in Ward ＇s triangle region using a computer. BMD of the hip in 30 volunteers was measured to evaluate BMD difference at different sides of the body. The change of BMD in Ward＇s triangle region in a short period of time was observed in 72 cases with a 3- 6 month follow-up. Results（ 1） The Ward ＇s triangle region was defined in the lowest value of BMD by automatic search with a computer. It located mostly near the bottom of the femoral neck（ 86. 7%）. It located out of the femoral neck in a small part of the subjects（ 5. 2%）,commonly in the greater trochanter,which was not co-existed with the anatomic location.（ 2） BMD of the Ward＇s triangle region was not the lowest in the upper femur in part of the subjects（ 8. 7%）,and the lowest value appeared in the greater trochanter.（ 3） The Ward＇s triangle region searched by computer automatically did not change the position obviously between different scans.（ 4） The accuracy deviation of BMD in the Ward＇s triangle region was 2. 27%,which was greater than that in the femoral neck（ 1. 05%） and in the greater trochanter（ 1. 57%）.（ 5） No significant difference was found in BMD between the right and left hip of the normal individuals（ P = 0. 32,P 〉0. 05）.（ 6） The change of BMD in the Ward＇s triangle region was earlier than that in the femoral neck and lumbar spine in 72 patients. Conclusion BMD of Ward＇s triangle region can be used for clinical follow-up with the standard position of the hip joint.