摘要
目的分析髋部肌肉面积、内脏脂肪面积(VFA)与老年骨质疏松症患者双能X射线测定法(DXA)骨强度参数的关系及对患者发生髋部骨折的预测价值。方法回顾性分析2021年1月—2022年6月四川省骨科医院收治的87例老年骨质疏松症(OP)患者的临床资料作为观察组,另取同期该院收治的41例老年骨量下降患者的临床资料作为对照组。对比观察组与对照组DXA骨强度参数、髋部肌肉面积、VFA。随访2年,根据老年OP患者是否发生髋部骨折,分为发生组与非发生组。对比发生组与非发生组的临床资料,分析老年OP患者发生髋部骨折的影响因素,分析臀中小肌肌肉截面面积(CSA)、臀大肌CSA、VFA及三者联合对老年OP患者发生髋部骨折的预测价值。结果观察组股骨干皮质比率、矩骨皮质比率、股骨颈皮质比率、截面模数、全髋骨密度(BMD)均低于对照组(P<0.05)。观察组臀中小肌CSA、臀大肌CSA均低于对照组(P<0.05),观察组VFA高于对照组(P<0.05)。臀中小肌CSA与股骨干皮质比率、矩骨皮质比率、股骨颈皮质比率、截面模数、全髋BMD均呈正相关(r=0.567、0.575、0.671、0.634和0.465,均P<0.05),臀大肌CSA与股骨干皮质比率、矩骨皮质比率、股骨颈皮质比率、截面模数、全髋BMD均呈正相关(r=0.589、0.667、0.532、0.479和0.586,均P<0.05),VFA与股骨干皮质比率、矩骨皮质比率、股骨颈皮质比率、截面模数、全髋BMD均呈负相关(r=-0.614、-0.652、-0.437、-0.483和-0.564,均P<0.05)。发生组年龄、类风湿性关节炎发生率、缺乏阳光照射例数占比、VFA均高于非发生组(P<0.05),全髋BMD、臀中小肌CSA、臀大肌CSA均低于非发生组(P<0.05)。全髋BMD[OR=0.385(95%CI:0.125,0.648)]、臀中小肌CSA[OR=0.252(95%CI:0.111,0.573)]、臀大肌CSA[OR=0.232(95%CI:0.101,0.527)]是老年OP患者发生髋部骨折的保护因素(P<0.05);VFA[OR=3.732(95%CI:1.641,8.490)]是老年OP患者发生髋部骨折的危险因素(P<0.05)。臀中小肌CSA、臀大肌CSA、VFA及三者联合预测老年OP患者发生髋部骨折的敏感性分别为77.78%(95%CI:0.519,0.926)、83.33%(95%CI:0.577,0.956)、88.89%(95%CI:0.639,0.981)、88.89%(95%CI:0.639,0.981),特异性分别为85.51%(95%CI:0.745,0.925)、82.61%(95%CI:0.712,0.903)、73.91%(95%CI:0.617,0.834)、92.75%(95%CI:0.832,0.973)。结论臀中小肌CSA、臀大肌CSA与老年OP患者DXA骨强度参数呈正相关,而VFA与老年OP患者DXA骨强度参数呈负相关,且三者联合预测老年OP患者发生髋部骨折的价值更高。
Objective To investigate the associations of hip muscle area and visceral fat area(VFA)with bone strength parameters measured by dual-energy X-ray absorptiometry(DXA)and their predictive values for hip fracture in elderly patients with osteoporosis.Methods We retrospectively analyzed clinical data from 87 elderly osteoporosis(OP)patients(observation group)and 41 elderly patients with low bone mass(control group)treated at Sichuan Orthopedic Hospital from January 2021 to June 2022.The bone strength parameters measured by DXA,the hip muscle area and VFA were compared between the observation group and the control group.The patients were followed up for 2 years,and the elderly individuals with OP were divided into the occurrence group and the non-occurrence group based on whether they experienced hip fractures.The clinical data of the occurrence group and the non-occurrence group were compared,and the influencing factors of hip fractures in elderly OP patients were analyzed.The predictive values of the cross-sectional area(CSA)of gluteus medius and gluteus minimus,CSA of gluteus maximus,VFA and their combination for hip fractures in elderly OP patients were determined.Results The cortical thickness ratios of the femoral shaft,talus,and the femoral neck,section modulus and total hip bone mineral density(BMD)in observation group were all lower than those in the control group(P<0.05).The CSA of gluteus medius and gluteus minimus and that of gluteus maximus in the observation group were lower than those in the control group(P<0.05),and the VFA in the observation group was higher than that in the control group(P<0.05).The CSA of gluteus medius and gluteus minimus was positively correlated with the cortical thickness ratios of femoral shaft,talus,and the femoral neck,section modulus and total hip BMD(r=0.567,0.575,0.671,0.634 and 0.465,all P<0.05).The CSA of gluteus maximus was positively correlated with the cortical thickness ratios of femoral shaft,talus,and the femoral neck,section modulus and total hip BMD(r=0.589,0.667,0.532,0.479 and 0.586,all P<0.05).The VFA was negatively correlated with the cortical thickness ratios of femoral shaft,talus,and the femoral neck,section modulus and total hip BMD(r=-0.614,-0.652,-0.437,-0.483 and-0.564,all P<0.05).The age,prevalence of rheumatoid arthritis,proportion of individuals lacking sunlight exposure and VFA in the occurrence group were higher than those in the non-occurrence group(P<0.05),and the total hip BMD,the CSA of gluteus medius and gluteus minimus and the CSA of gluteus maximus in the occurrence group were lower than those in the non-occurrence group(P<0.05).High total hip BMD[OR=0.385(95%CI:0.125,0.648)],CSA of gluteus medius and gluteus minimus[OR=0.252(95%CI:0.111,0.573)],and CSA of gluteus maximus[OR=0.232(95%CI:0.101,0.527)]were protective factors for hip fractures in elderly OP patients(P<0.05),while high VFA[OR=3.732(95%CI:1.641,8.490)]was a risk factor for hip fractures in elderly OP patients(P<0.05).The sensitivities of the CSA of gluteus medius and gluteus minimus,CSA of gluteus maximus,VFA and their combination for predicting hip fractures in elderly OP patients were 77.78%(95%CI:0.519,0.926),83.33%(95%CI:0.577,0.956),88.89%(95%CI:0.639,0.981),and 88.89%(95%CI:0.639,0.981),with the respective specificities being 85.51%(95%CI:0.745,0.925),82.61%(95%CI:0.712,0.903),73.91%(95%CI:0.617,0.834),and 92.75%(95%CI:0.832,0.973).Conclusions The CSA of gluteus medius and gluteus minimus and that of gluteus maximus are positively but the VFA is negatively correlated with bone strength parameters measured by DXA in elderly OP patients.The combination of the three indicators yields a higher predictive value for hip fractures in elderly OP patients.
作者
梁译文
刘敏
刘愉勤
高艳
Liang Yi-wen;Liu Min;Liu Yu-qin;Gao Yan(Department of Medical Imaging,Sichuan Orthopedic Hospital,Chengdu,Sichuan 610041,China)
出处
《中国现代医学杂志》
CAS
2024年第24期1-7,共7页
China Journal of Modern Medicine
基金
四川省卫生健康委员会科研项目(No:2021609)。