跟骨超声骨密度在足部废用性骨质疏松症诊断中的应用

Applied value of quantitative ultrasound of heel in the diagnosis of foot disuse osteoporosis

目的探讨足跟部骨定量超声(quantitative ultrasound,QUS)检查骨密度(bone mineral density,BMD)在诊断足部废用性骨质疏松症中的临床应用价值。方法本研究对2016年6~12月于我院足踝外科门诊就诊的单足损伤后限制活动超过3个月以上的80例病人进行双足跟骨QUS检查和患足X线检查。其中男27例、女53例,年龄为18~59岁、平均(45.72±12.46)岁,右足损伤58例、左足损伤22例,平均制动或限制活动时间为(4.12±0.83)个月。BMD结果分别按照T值法和骨量丢失法进行分析,参照X线诊断标准对跟骨QUS诊断足部废用性骨质疏松症的敏感性进行评价。结果将80例病人两侧跟骨BMD数值依据骨量丢失百分率法计算:诊断为骨质疏松者24例、骨量减少者10例,漏诊18例,无误诊,敏感度为57.1%。与T值法敏感性分析(14.3%)比较明显提高,差异具有统计学意义(u=6.9325,P<0.05)。结论骨量丢失法优于T值法,但QUS诊断足部废用性骨质疏松症的敏感性低于X线法,仅能作为足部废用性骨质疏松症的初筛方法。

Objective To investigate the clinical application of quantitative ultrasound(QUS)of the heel for bone mineral density(BMD)scan in the diagnosis of foot disuse osteoporosis.Methods Eighty patients diagnosed as having single foot injury in clinic between June and December in 2016 were consented in this study with criteria of movement restriction for more than 3 months.The age of these patients(27 males,and 53 female)ranged from 18 to 59 years,with a median age of 45.72±12.46.Fifty-eight patients had injury at the right foot,and rest 22 cases got injured on the left.The average movement restriction time was 4.12±0.83 months.Dual calcaneus was tested with QUS,and the diseased foot was examined with X-ray to confirm foot disuse osteoporosis.BMD was analyzed by both T value and loss of bone mass methods.Results By calculating the percentage of bone mass loss with BMD value from dual calcaneus of 80 patients,we identified 24 cases of osteoporosis and 10 patients with loss of bone mass.The number of false positive and false negative cases was 0 and 18,respectively.The sensitivity of this method was 57.1%,which was statistically(u=6.9325,P<0.05)far better than that of T value-based QUS(14.3%).Conclusion The loss of bone mass method was superior over T value in the diagnosis of foot disuse osteoporosis.However,the fact that QUS only gives suboptimal sensitivity as compared to X-ray limits its application in the diagnosis of foot disuse osteoporosis.