骨密度预测脊柱和髋部脆性骨折先后性的研究

Study on bone mineral density in predicting the sequence of spinal or hip fragility fractures

目的通过观察分析髋部(股骨颈)和脊柱(胸腰椎)脆性骨折患者的骨密度值,探讨骨密度预测髋部和脊柱脆性骨折风险。方法采用回顾性研究方法,收集2017年1月至2018年12月浙江省台州医院符合纳入标准的股骨颈与胸腰椎脆性骨折患者的临床资料98例,按骨折史分为股骨颈组53例和胸腰椎组45例,比较两组致伤因素、骨密度及跌倒致伤因素下骨密度差异。结果两组致伤因素比较,股骨颈组跌倒最多,为84.25%,与胸腰椎组的39.16%比较,差异有统计学意义(P=0.002);胸腰椎组无明显外伤病史患者较多,与股骨颈组比较,差异有统计学意义(P=0.033);两组暴力致伤因素比较,差异无统计学意义(P>0.05)。胸腰椎组腰椎T值为(-3.66±0.89),与股骨颈T值的(-2.56±0.73)比较,差异有统计学意义(P=0.006);胸腰椎组△T为(-1.10±0.91),股骨颈组△T为(-0.28±0.76),两组比较,差异有统计学意义(P=0.001);其余指标比较,差异无统计学意义(P>0.05)。跌倒致伤因素下,胸腰椎组腰椎T值为(-3.07±0.78),股骨颈T值(-1.94±0.08),两者比较,差异有统计学意义(P=0.003);两组股骨颈T值比较,差异有统计学意义(P=0.002);两组△T比较,差异有统计学意义(P=0.000);其余指标比较,差异无统计学意义(P>0.05)。结论对于老年患者,跌倒更容易出现脆性骨折;腰椎与股骨颈骨密度差值越大,越容易出现胸腰椎骨折,反之更容易出现股骨颈骨折。

Objective To observe and analyze the bone mineral density of patients with fragility fractures of the hip(femoral neck)and spine(thoracolumbar spine),and to predict the risk of fragility fractures of the hip and the spine.Methods Retrospective research method was used,the patients with fragility fractures of the femoral neck and thoracolumbar spine who met the inclusion criteria from January 2017 to December 2018 in Taizhou Hospital of Zhejiang Province were collected.A total of 98 subjects were included.According to the fracture history,they were divided into 53 cases in the femoral neck group and 45 cases in the thoracolumbar spine group.The injury factors and bone density were compared between the two groups,the differences in bone mineral density between the two groups were analyzed under the injury factors of falls.Results Among the injury factors,the femoral neck group had the most falls(84.25%),which was significantly different from the thoracolumbar spine group(39.16%)(P=0.002);the thoracolumbar spine group had more cases of no history of trauma,which was significantly different from the femoral neck group(P=0.033).There was no statistically significant difference in violence factors between groups(P>0.05).In terms of bone mineral density,there was a significant difference between the femoral neck T value(-2.56±0.73)and the lumbar bone mineral density T value(-3.66±0.89)in the thoracolumbar spine group(P=0.006).The△T value in the thoracolumbar spine group was(-1.10±0.91),and the△T value in the femoral neck fracture group was(-0.28±0.76).There was a significant difference in the△T values between the two groups(P=0.001),there was no difference in other values(P>0.05).There was a statistically significant difference between the femoral neck T value(-1.94±0.08)and the lumbar spine T value(-3.07±0.78)in the thoracolumbar spine group during a fall(P=0.003),the△T value in both groups with significant difference(P=0.000),there was no difference in other values(P>0.05).Conclusion In elderly patients,falls are more likely to cause fragility fractures.The greater the difference in bone mineral density between the lumbar spine and the femoral neck,the more likely thoracolumbar fractures will appear.Otherwise,the femoral neck fractures will be more likely to appear.