骨质疏松患者下颌骨骨密度的研究

Study of bone mineral density in the mandible of patients with osteoporosis

目的探讨下颌体、下颌支做为骨密度随访指标的临床意义。方法采用双能X线骨密度(美国Norland XR-800骨密度仪),记录分析正常志愿组(85例)及骨质疏松组患者(170例)3个月、6个月及12个月内下颌体、下颌支、股骨颈、Ward区间、L2-4骨密度随时间的变化规律及临床特点。结果骨质疏松组患者L2-4[(0.783±0.160)g/cm^2比(1.251±0.217)g/cm^2]、Ward区[(0.476±0.081)g/cm^2比(0.732±0.037)g/cm^2]、股骨颈[(0.764±0.097)g/cm^2比(0.892±0.112)g/cm^2]、下颌体[(1.369±0.345)g/cm^2比(1.649±0.440)g/cm^2]、下颌支[(0.891±0.340)g/cm^2比(1.372±0.593)g/cm^2]的BMD均显著低于正常志愿组,差异有统计学意义(P <0.001)。骨质疏松组患者经多次测量,下颌体、下颌支由机器自动标记的感兴趣区的矩形区位置基本一致。骨质疏松组患者治疗3个月后下颌体[(1.662±0.524)g/cm^2比(1.369±0.345)g/cm^2]、下颌支[(1.273±0.475)g/cm^2比(0.891±0.340)g/cm^2]的BMD均较治疗前有显著变化,差异有统计学意义(P <0.001)。Ward区、股骨颈、L2-4的BMD与治疗前比较,差异无统计学意义。骨质疏松组患者治疗6个月后下颌体[(1.645±0.293)g/cm^2比(1.369±0.345)g/cm^2]、下颌支[(1.266±0.399)g/cm^2比(0.891±0.340)g/cm^2]、Ward区[(0.506±0.079)g/cm^2比(0.476±0.081)g/cm^2]的BMD均较治疗前显著增长,差异有统计学意义(P <0.001),但股骨颈、L2-4的BMD与治疗前比较,差异无统计学意义。骨质疏松组患者治疗12个月后下颌体[(1.966±0.458)g/cm^2比(1.369±0.345)g/cm^2]、下颌支[(1.465±0.326)g/cm^2比(0.891±0.340)g/cm^2]、Ward区[(0.526±0.068)g/cm^2比(0.476±0.081)g/cm^2]、股骨颈[(0.791±0.086)g/cm^2比(0.764±0.097)g/cm^2]及L2-4[(0.823±0.148)g/cm^2比(0.783±0.160)g/cm^2]的BMD均较治疗前显著增长,差异有统计学意义(P <0.001)。结论下颌骨骨密度变化敏感性高,可以做为骨质疏松患者临床随访指标。

Objective To investigate the clinical significance of mandibular and mandibular branches as followup indicators of bone mineral density.Methods Two-energy X-ray bone mineral density(Norland XR-800 bone density meter)was used to record and analyze the normal volunteer group(85 cases)and the osteoporosis group(170 cases)within 3 months,6 months and 12 months.The changes of the mandibular body,mandibular branch,femoral neck,Ward interval and L2-4 bone density with time and clinical characteristics.Results In the osteoporosis group,L2-4[(0.783±0.160)g/cm^2 vs(1.251±0.217)g/cm^2],Ward area [(0.476±0.081)g/cm^2 vs(0.732±0.037)g/cm^2],femoral neck[(0.764±0.097)g/cm^2 vs(0.892±0.112)g/cm^2],mandibular body[(1.369±0.345)g/cm^2 vs(1.649±0.440)g/cm^2],mandibular branch[(0.891±0.340)g/cm^2 vs(1.372±0.593)g/cm^2]was significantly lower than that of the normal volunteer group,and the difference was statistically significant(P <0.001).In the osteoporosis group,the position of the rectangular region of the region of interest of the mandibular body and the mandibular branch automatically marked by the machine was basically the same.In the osteoporosis group,the mandibular body was treated after 3 months[(1.662±0.524)g/cm^2 vs(1.369±0.345)g/cm^2],mandibular branch[(1.273±0.475)g/cm^2 vs(0.891±0.340)g/cm^2]was significantly different from that before treatment,and the difference was statistically significant(P <0.001).There was no significant difference in the BMD between Ward area,femoral neck and L2-4 before treatment.In the osteoporosis group,the mandibular body after 6 months of treatment[(1.645±0.293)g/cm^2 vs(1.369±0.345)g/cm^2],mandibular branch[(1.266±0.399)g/cm^2 vs(0.891±0.340)g/cm^2],Ward area[(0.506±0.079)g/cm^2 vs(0.476±0.081)g/cm^2]BMD were significantly increased compared with before treatment,the difference was statistically significant(P <0.001),but the femoral neck,L2 The BMD of-4 was not significantly different from that before treatment.In the osteoporosis group,the mandibular body was treated after 12 months[(1.966±0.458)g/cm^2 vs(1.369±0.345)g/cm^2],and the mandibular branch[(1.465±0.326)g/cm^2 vs(0.891±0.340)g/cm^2],Ward area[(0.526±0.068)g/cm^2 vs(0.476±0.081)g/cm^2],femoral neck[(0.791±0.086)g/cm^2 vs(0.764±0.097)g/cm^2]and L2-The BMD of 4[(0.823±0.148)g/cm^2 vs(0.783±0.160)g/cm^2]was significantly higher than that before treatment,and the difference was statistically significant(P <0.001).Conclusion The sensitivity of mandibular bone mineral density is high and can be used as a clinical follow-up index for patients with osteoporosis.