股骨近端骨质CT影像相关指标测量预测老年人髋部骨折的临床意义

Significance of CT measurement of proximal femur bone in elderly patients with hip fracture

目的探讨股骨近端骨质CT影像相关指标测量在老年人髋部骨折预测中的临床意义,为预防髋部骨折提供相关依据。方法回顾性分析2020年1月至2021年1月在首都医科大学大兴教学医院和首都医科大学宣武医院行髋部CT检查的120例疑似骨折患者作为研究对象,根据患者是否发生骨折分为骨折组及非骨折组,均60例。两组患者均进行CT检测,对比股骨头、股骨颈及转子间的CT值、骨皮质厚度及骨密度差异,并通过受试者工作特征(ROC)曲线探究CT影像学参数对髋部骨折的预测价值。结果骨折组患者股骨头、股骨颈及转子间的松质骨CT测量值均明显低于非骨折组,差异均有统计学意义(P<0.05)。骨折组转子间内侧皮质厚度、转子间外侧皮质厚度、股骨颈内侧皮质厚度、股骨颈外侧皮质厚度均明显低于非骨折组,差异均有统计学意义(P<0.05)。骨折组股骨头、股骨颈及转子间骨密度均明显低于非骨折组,差异均有统计学意义(P<0.05)。CT影像测量相关指标与骨折的ROC曲线分析显示,各指标与骨折的AUC曲线面积大小依次为:股骨颈外侧皮质厚度(0.865)、转子间外侧皮质厚度(0.845)、转子间骨密度(0.722)、股骨颈骨密度(0.705)、转子间CT值(0.701)、转子间内侧皮质厚度(0.680)、股骨头骨密度(0.660)、股骨颈CT值(0.653)及股骨颈内侧皮质厚度(0.610)。结论老年髋部骨折患者存在股骨头、股骨颈及转子间的CT值、骨皮质厚度及骨密度降低,了解CT影像参数变化对老年髋部骨折的发生具有预测作用。

Objective To investigate the CT measurement of proximal femur bone in the elderly with hip fracture,and explore the relationship to provide a basis for understanding the factors of hip fracture.Methods A retrospective analysis was performed on 120 patients who underwent hip CT examination in Daxing Teaching Hospital,Medical University Capital and Xuanwu Hospital of Capital Medical University from January 2020 to January 2021,and they were divided into fracture group and non-fracture group according to whether fracture occurred,including 60 patients.CT examination was performed in both groups to compare CT values of femoral head,femoral neck and intertrochanter,bone cortical thickness and bone mineral density(BMD),and to explore the predictive effect of imaging parameters on hip fracture by receiver operating characteristic(ROC).Results Compared with the non-fracture group,CT measurements of cancellous bone of femoral head,femoral neck and intertrochanteric in fracture group were decreased,the differences were statistically significant(P<0.05).Compared with the non-fracture group,the thickness of medial intertrochanteric cortex,lateral intertrochanteric cortex,medial femoral neck cortex and lateral femoral neck cortex in fracture group were decreased,and the differences were statistically significant(P<0.05).Compared with non-bone group,bone mineral density of femoral head,femoral neck and intertrochanteric was decreased in fracture group,and the differences were statistically significant(P<0.05).The ROC curve analysis of CT imaging measurements and fracture showed that the AUC curve area of each index and fracture was successively:Femoral neck lateral cortical thickness(0.865),intertrochanteric lateral cortical thickness(0.845),intertrochanteric BMD(0.722),femoral neck BMD(0.705),intertrochanteric CT value(0.701),intertrochanteric medial cortical thickness(0.680),femoral head BMD(0.660),femoral neck CT value(0.653)And femoral neck medial cortical thickness(0.610).Conclusion The CT values of femoral head,femoral neck and intertrochanteric,bone cortical thickness and bone mineral density were decreased in the elderly patients with hip fracture.It is believed that understanding the changes of CT image parameters can predict the occurrence of hip fracture in the elderly.