CAJ | 학술논문

目的：分析宫颈癌患者放射治疗后盆腔不全骨折（PIF ）的临床特征并探讨影响其发生的危险因素。方法选择2007年2月至2010年5月在该院采用放射治疗作为单独治疗方法的55例宫颈癌患者，分析其临床特征。随访2年，通过C T和（或）磁共振成像观察患者脊柱、骶骨、骶髂关节、髂骨、耻骨和股骨头的骨折情况并检测患者C T片上第5腰椎（L5）椎体、左侧骶骨和右侧骶骨的密度，探讨不同因素对PIF发病率的影响。结果随访2年后55例患者中有12例（19个部位）患者发生PIF ，累积发生率为21．82％；患者PIF部位分布为：腰椎椎体5例，骶骨5例，耻骨4例，骶髂关节2例，髂骨2例和股骨头1例。CT片上第5腰椎椎体密度“≤130 H U”和“＞130 H U”时患者 PIF发病率分别为16．36％和5．45％，左侧骶骨密度“≤-35 H U”和“＞-35 H U”患者PIF发病率分别为18．18％和3．64％，右侧骶骨密度“≤-35 H U”和“＞-35 H U”患者PIF发病率分别为20．00％和1．82％，3个部位CT片密度在PIF发病率方面差异均有统计学意义（P＜0．05）。单因素分析表明，绝经状态和CT 片平均密度对PIF的发生有影响（P＜0．05）；多因素分析显示，CT片平均密度是影响宫颈癌患者放射治疗后 PIF发生的独立影响因素。结论宫颈癌患者放射治疗后可能发生PIF ，其发病与绝经状态和骨密度有关。
목적：분석궁경암환자방사치료후분강불전골절（PIF ）적림상특정병탐토영향기발생적위험인소。방법선택2007년2월지2010년5월재해원채용방사치료작위단독치료방법적55례궁경암환자，분석기림상특정。수방2년，통과C T화（혹）자공진성상관찰환자척주、저골、저가관절、가골、치골화고골두적골절정황병검측환자C T편상제5요추（L5）추체、좌측저골화우측저골적밀도，탐토불동인소대PIF발병솔적영향。결과수방2년후55례환자중유12례（19개부위）환자발생PIF ，루적발생솔위21．82％；환자PIF부위분포위：요추추체5례，저골5례，치골4례，저가관절2례，가골2례화고골두1례。CT편상제5요추추체밀도“≤130 H U”화“＞130 H U”시환자 PIF발병솔분별위16．36％화5．45％，좌측저골밀도“≤-35 H U”화“＞-35 H U”환자PIF발병솔분별위18．18％화3．64％，우측저골밀도“≤-35 H U”화“＞-35 H U”환자PIF발병솔분별위20．00％화1．82％，3개부위CT편밀도재PIF발병솔방면차이균유통계학의의（P＜0．05）。단인소분석표명，절경상태화CT 편평균밀도대PIF적발생유영향（P＜0．05）；다인소분석현시，CT편평균밀도시영향궁경암환자방사치료후 PIF발생적독립영향인소。결론궁경암환자방사치료후가능발생PIF ，기발병여절경상태화골밀도유관。
Objective To analyse the clinical features of pelvic insufficiency fractures (PIF) in patients with cervical cancer after radiotherapy and explore the risk factors affecting its occurrence .Methods 55 cases of patients with cervical cancer that used radia-tion therapy as a single treatment were chosen in our hospital from February 2007 to May 2010 and the clinical features were ana-lysed;The fractures of spine ,sacrum ,sacroiliac joint ,ilium and pubis and femoral were observed and the density of fifth lumbar (L5 ) vertebrae ,left and right sacrum were detected via the CT or MRI (Hounsfield Unit)after 2-year follow-up ,the different factors on the incidence of PIF were explored .Results 12 cases (19 sites) of patients in 55 patients occured PIF after follow-up 2years ,the cumulative incidence was 21 .82% ;the distribution of PIF parts were followed :lumbar vertebrae had 5 cases ,sacral had 5 cases ,pu-bis had 4 cases ,sacroiliac joint had 2 cases ,iliac had 2 cases and femoral head had 1 case .The incidence rate of PIF that density of fifth lumbar vertebrae was ≤130 HU and >130 HU were 16 .36% and 5 .45% respectively ,the PIF′incidence rate that density of left side of sacrum was≤ -35 HU and > -35 HU were 18 .18% and 3 .64% respectively ,the incidence rate of PIF that density of right side of sacrum was ≤ -35 HU and > -35 HU were 20 .00% and 1 .82% respectively ,the density of the three parts all had statistical difference on the incidence of PIF (P<0 .05) .Univariate analysis showed that menopausal status and the average density of CT had statistical effects on PIF (P<0 .05);Multiple analysis showed that the average density of CT was the independent factors affecting PIF′incidence after radiotherapy .Conclusion The patients with cervical cancer may occur pelvic insufficiency fracture af-ter radiotherapy ,and its incidence is related to menopausal status and bone mineral density .