CAJ | 학술논문

目的探讨骨密度及股骨颈结构参数在脆性股骨颈骨折患者的变化及其与股骨颈骨折的关系. 方法将102例患者分为骨折组(59例)和非骨折组(43例)二组.对所有患者的健侧股骨近端行CT扫描及骨密度测定(采用股骨颈骨密度),并利用CT扫描的定位像进行健侧股骨颈区结构参数测量. 结果骨折组患者股骨颈骨密度下降、股骨颈皮质厚度变薄、皮质厚度比率下降(均P=0.000);股骨颈宽度、颈中段髓腔宽度在两组比较患者差异无统计学意义(P=0.937和0.073).在50～64岁的年龄段,骨折组患者股骨颈的骨密度降低(P=0.013);在65岁以上的年龄段,股骨颈骨密度在两组比较差异无统计学意义(P=0.114);在50～64岁及65岁以上的年龄段里,股骨颈皮质厚度变薄、皮质厚度比率下降(均P=0.000).两组骨量减少及骨质疏松患者比较,骨折组与非骨折组比较股骨颈皮质厚度变薄、皮质厚度比率下降(均P＜0.01). 结论股骨颈皮质骨变薄、骨密度下降与股骨颈骨折密切相关;骨密度快速下降期主要集中在50～64岁,适合于该年龄段股骨颈骨折的风险评估;而在65岁以上的年龄段,皮质骨变薄是股骨颈骨强度下降的主要因素,也是老年人发生脆性股骨颈骨折的重要因素.
목적 탐토골밀도급고골경결구삼수재취성고골경골절환자적변화급기여고골경골절적관계. 방법 장102례환자분위골절조(59례)화비골절조(43례)이조.대소유환자적건측고골근단행CT소묘급골밀도측정(채용고골경골밀도),병이용CT소묘적정위상진행건측고골경구결구삼수측량. 결과 골절조환자고골경골밀도하강、고골경피질후도변박、피질후도비솔하강(균P=0.000);고골경관도、경중단수강관도재량조비교환자차이무통계학의의(P=0.937화0.073).재50～64세적년령단,골절조환자고골경적골밀도강저(P=0.013);재65세이상적년령단,고골경골밀도재량조비교차이무통계학의의(P=0.114);재50～64세급65세이상적년령단리,고골경피질후도변박、피질후도비솔하강(균P=0.000).량조골량감소급골질소송환자비교,골절조여비골절조비교고골경피질후도변박、피질후도비솔하강(균P＜0.01). 결론 고골경피질골변박、골밀도하강여고골경골절밀절상관;골밀도쾌속하강기주요집중재50～64세,괄합우해년령단고골경골절적풍험평고;이재65세이상적년령단,피질골변박시고골경골강도하강적주요인소,야시노년인발생취성고골경골절적중요인소.
Objective To study the changes of bone mineral density (BMD) and structural parameters of femoral neck in fragile femoral neckfracture,and to investigate the relationship between the changes and occurrence of fragile fracture of femoral neck.Methods 102 patients were divided into fracture group (n=59) and non-fracture group (n=43).There were 18 males and 41 females [[mean age (74.0±9.3) yrs,ranged 53-88 yrs] in fracture group and 16 males and 27 females [mean age (64.3±9.9)] yrs,ranged 50-82 yrs in non-fracture group.CT scan and BMD in the femoral neck were collected in all patients.The structural parameters of the femoral neck in CT scan were measured with medical image analysis software.Results BMD was lower,cortical thickness of femoral neck (FNCT) was thinner and the ratio (FNCT/FNW) of cortical thickness (FNCT) over femoral neck width (FNW) was lower in fracture group than in non-fracture group (all P＜0.001),but there were no statistically significant differences in femoral neck width (FNW) and femoral medullary cavity width (FMCW) between the two groups (both P＞0.05).The BMD of femoral neck was markedly decreased in the fracture group as compared with the non-fracture group in patients aged 50-64 yrs (P ＜0.05),and there were no statistically significant differences in the changes of the femoral neck BMD between the two groups in patients aged over 65 yrs (P＜0.05).In both of patients aged 50-64 yrs and more than 65 yrs,FNCT was thinner and ratio of FNCT/FNW was lower in the fracture group than in the non-fracture group (both P＜0.05).The patients with osteopenia and osteoporosis had thinner FNCT and lower ratio of FNCT/FNW in the fracture group than in the non-fracture group of the patients with osteopenia and osteoporosis (both P＜ 0.01).Conclusions Lower BMD and thinner cortical thickness of femoral neck are closely related to the fragile fracture of femoral neck.The phase of femoral neck BMD rapid decline is mainly in the age of 50-65 yrs,which is consistent with the risk assessment for fragile fracture in femoral neck.The decrease of cortical thickness of femoral neck on FNCT is the main factor for the decreased femoral neck strength in patients aged over 65 yrs,which is also an important factor for the fragile fracture of femoral neck in the elderly aged over 65 yrs.