女性髋部骨质疏松性骨折患者股骨近端几何结构对患者骨折危险的影响

Effect of the proximal femur geometry on the risk of facture in female patients with osteoporotic hip facture

目的研究女性髋部骨质疏松性骨折患者股骨近端几何结构对患者骨折危险的影响,以及股骨近端几何结构是否是独立于骨密度之外与髋骨骨折密切相关的危险因素。方法 2013年5月—2016年7月延安市人民医院骨科收治171例65周岁以上髋部骨质疏松性骨折女性患者(试验组,其中股骨颈骨折97例,股骨粗隆间骨折74例),另在同时期门诊收治65周岁以上骨质疏松症女性患者386例(对照组),采用双能X线吸收分析技术(DXA)分析比较这两组患者的骨密度(BMD)差异,并分析股骨近端几何结构与两种髋骨骨折之间的相关性。结果两组的体重、股骨颈横截面积(CSA)、股骨颈长(NL)、股骨颈宽与股骨近端骨密度差异有统计学意义(P<0.05)。其中对照组股骨近端骨密度比试验组高(P<0.05)。此外,在股骨颈骨折组中,股骨颈横截面积与股骨颈长骨折的比值比(OR)分别降低了1.98和1.72倍,而股骨颈宽骨折的OR增加了1.52倍;在粗隆间骨折组中,股骨颈宽骨折的OR则增加了1.44倍(P<0.05),并且这些OR与股骨近端骨密度没有相关性。结论股骨颈宽是除骨密度以外独立的与女性髋骨骨折密切相关的危险因素。

Objective To investigate the influence of proximal femur geometry on fracture risk in female patients with osteoporotic fracture of femur,and to explore whether the proximal femoral geometry is a risk factor closely related to hip fracture.Methods The study was carried out based on 171 women who were at least 65 years old and hospitalized with osteoporotic hip fractures from May 2013 to Jul.2016 in Yan an People s Hospital.They were taken as trial group,including 97 cases of femur neck fractures and 74 cases of intertrochanteric fractures.The 386 female patients with osteoporosis were taken as control group,who were treated in our hospital during the same time.Femur bone mineral density(BMD)and proximal femoral geometry for all subjects were measured with dual energy X-ray absorptiometry,and compared between the two groups.Furthermore,the correlation between the geometric structure of the proximal femur and the two kinds of hip fractures were analyzed.Results The trial group and control group had significant differences in weight,cross-sectional area,length,width of femoral neck and BMD of proximal femur(P<0.05).What s more,the BMD of proximal femur in the control group was much higher than that in the trial group.For the femoral neck fractures group,regardless of BMD,the odds ratio for fractures in the cross-sectional area and neck length of femur were decreased by 1.98 times and 1.72 times,respectively,while the odds ratio for fracture were increased by 1.52 times in the femoral neck width.For intertrochanteric fracture group,the odds ratio for fractures were increased by 1.44 times in the femoral neck width regardless of BMD.Conclusion The femoral neck width is an independent risk factor associated with female hip fractures in addition to bone density.