骨密度及骨代谢指标在脊柱骨疏骨折中的临床研究

发布时间：2018-03-08 10:00

本文选题：骨质疏松　切入点：甲状旁腺激素　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:了解脊柱骨疏骨折中骨密度值和骨代谢生化指标的状况,探索骨密度及骨代谢在脊柱骨质疏松性骨折中的应用价值,以期为脊柱骨质疏松骨折提供完善的诊断及治疗策略。方法:依据纳入标准和排除标准搜集2015年1月~2016年1月期间就诊于宁夏人民医院脊柱骨科,发生脆性脊柱骨折的60岁以上老年患者共60例作为研究对象,所有入选患者均常规行胸腰段X线、CT及MRI检查,然后检测各患者的腰椎(L1-L4)和双侧髋部骨密度,并依据测得的骨密度值分组,任一部位的T值评分-2.5即为非骨质疏松组,任一部位的T值评分≤-2.5即为骨质疏松组。骨质疏松组共34例,其中男性14例,女性20例,女性患者均为绝经后妇女,年龄为61-85岁,平均年龄为70岁。非骨质疏松组共26例,其中男性9例,女性17例,女性均为绝经后妇女,年龄为60-86岁,平均年龄为68.7岁,两组间的年龄经对比无统计学意义,具有可比性。记录各组患者的碱性磷酸酶(ALP),骨钙素(BGP),甲状旁腺激素(PTH),25羟维生素D(25-OH-VD)等骨代谢生化指标以及观察X线、CT及MRI等影像学表现。依据Oswestry功能障碍指数评分表(Oswestry dysfunction index ODI)、Wong-Banker面部表情量表法(FPS-R)对60例脆性骨折患者的临床症状进行量化评估,然后对比分析两组间骨代谢生化指标变化情况以及临床表现状况,以及统计分析骨密度的检测部位与年龄的关系、不同标准下的骨质疏松检出率的差异,并探讨发生脆性骨折患者中骨密度值却未达到骨质疏松的可能原因。结果:两组间患者年龄、性别的比较结果:两组间患者的年龄、性别对比无统计学意义(P0.05),两组间具有可比性;两组间四种骨代谢指标的对比结果:发生脆性骨折的脊柱骨折患者中,依据骨密度分为非骨质疏松组中的甲状旁腺激素含量、骨钙素含量、25-羟基维生素D及碱性磷酸酶与骨质疏松组无统计学意义;非骨质疏松组与骨质疏松组ODI指数评分对比结果:非骨质疏松组ODI指数评分平均57.90分,骨质疏松组ODI指数评分平均59.67分,两组间ODI指数评分对比无统计学意义;非骨质疏松组与骨质疏松组FPS-R评分对比结果:非骨质疏松组FPS-R评分平均(7.5±0.5)分,骨质疏松组FPS-R评分平均(7.9±0.7)分,两组间FPS-R评分对比无统计学意义;最低T值评分在不同部位检出的患者年龄比较结果:骨密度的最低T值评分出现在腰椎的患者平均年龄65岁,骨密度的最低T值评分出现在髋部的患者平均年龄73岁,差异有统计学意义;不同判定标准下的骨质疏松检出率比较结果:以2.0SD为诊断标准的骨质疏松检出率为75%,以2.5SD为诊断标准的骨质疏松检出率为50%,差异有统计学意义;60例脆性脊柱骨折患者在影像学表现:均可见除压缩椎体以外的胸腰椎骨密度减低,骨小梁稀疏,骨皮质变薄,出现栅状排列的纵行骨小梁,压缩的椎体呈楔形、双凹形或扁平形的骨疏骨折表现。结论:(1)应用DEXA测定的骨密度值因受检测部位、诊断标准不统一、国家、种族、技术人员检测水平不同以及自身不足等方面的影响,不一定能对所有脊柱骨疏骨折患者做出精确诊断,在临床应用中存在着一定的局限性。(2)骨代谢指标可以评估脊柱骨疏骨折患者的骨转换情况,在脊柱骨疏骨折的辅助诊断中有着一定的应用价值。(3)对于老年脊柱骨折患者,骨密度联合骨代谢生化指标、受伤经过、影像学表现可以更加准确的判断骨折是否是骨质疏松所引起的病理性骨折。
[Abstract]:Objective: To investigate the spinal osteoporotic fracture bone density and biochemical markers of bone metabolism, to explore the application value of bone mineral density and bone metabolism in osteoporotic vertebral fracture, in order to provide diagnostic and therapeutic strategies for improving osteoporotic vertebral fractures. Methods: according to the inclusion criteria and exclusion criteria were collected during January 2015 ~2016 January Department of orthopedics, people's Hospital of Ningxia during the spine, the brittle fracture of spine over the age of 60 elderly patients with a total of 60 cases as the research object, all patients were underwent thoracic X-ray, CT and MRI examination, and detection of lumbar patients (L1-L4) and bilateral hip bone mineral density and bone mineral density on the basis of the measured value of the packet any part of the T score, -2.5 is the non osteoporosis group, any part of the T score is less than -2.5 in osteoporosis group. Osteoporosis group were 34 cases, including 14 cases of male, 20 cases of women, women Who were postmenopausal women, age is 61-85 years old, the average age is 70 years old. The non osteoporosis group were 26 cases, including 9 cases of male, female 17 cases, women were postmenopausal women, age 60-86 years old, the average age was 68.7 years, compared with no statistical significance between the two groups in age. Comparable. Records of alkaline phosphatase of patients in each group (ALP), osteocalcin (BGP), parathyroid hormone (PTH), 25 hydroxyvitamin D (25-OH-VD) and other biochemical markers of bone metabolism and X-ray observation, the expression of CT and MRI imaging. According to Oswestry disability index score (Oswestry dysfunction, Wong-Banker index ODI) facial scale method (FPS-R) to evaluate the clinical symptoms of 60 cases of fragility fractures, and then the comparative analysis between the two groups of biochemical markers of bone metabolism changes and clinical manifestations, and statistical analysis of the relationship between bone density testing site and age, not The difference with the detection rate under the standard of osteoporosis, and to explore the possible causes of brittle fracture of bone density in patients with osteoporosis did not reach values. Results: two groups of patients age, gender comparison between two groups of patients age, gender comparison was not statistically significant (P0.05), the two groups are comparable the comparison results between the two groups; four kinds of bone metabolism index: brittle fracture of spine fracture patients, bone density is divided into parathyroid hormone content, non osteoporosis group in the osteocalcin content, 25- hydroxy vitamin D and alkaline phosphatase and osteoporosis group had no statistical significance; the non osteoporosis group and osteoporosis results: Compared with group ODI index ODI index non osteoporosis group score was 57.90, osteoporosis group ODI index score was 59.67, ODI index score between the two groups was not statistically significant compared with the non osteoporosis group; Osteoporosis group FPS-R score comparison results: non osteoporosis group average FPS-R score (7.5 + 0.5), osteoporosis group average FPS-R score (7.9 + 0.7) points, FPS-R scores between the two groups comparison was not statistically significant; score detected in different parts of the age comparison results of minimum T values: minimum T bone density the average score in the average age of the patients with lumbar at the age of 65, the lowest T bone density score in the average age of patients with hip at the age of 73, the difference was statistically significant; different criteria for the prevalence of osteoporosis results: using 2.0SD as the diagnostic criteria of osteoporosis detection rate was 75%, with 2.5SD diagnosis the prevalence of osteoporosis was 50%, the difference was statistically significant; 60 cases of spinal fractures in brittle features: can see images of thoracolumbar spinal vertebral compression density except outside decreased trabecular thinning, cortical thinning, grating The longitudinal bone trabecular arrangement, vertebral wedge-shaped bone thinning, concave or flat fracture. Conclusion: (1) bone mineral density DEXA was used to determine the value of detection by site, diagnosis standard is not unified, national, racial, effects of technical personnel detection level and different aspects of their own is not enough and not be able to make accurate diagnosis of all spinal osteoporotic fracture patients in the clinical application, there are some limitations. (2) bone metabolism index can evaluate spinal osteoporotic fracture patients with bone transformation, has a certain application value in the diagnosis of spinal osteoporotic fractures (3) for the. Elderly patients with spinal fracture, biochemical index, density of bone metabolism bone injuries through imaging, can more accurately determine whether the fracture is a pathologic fracture caused by osteoporosis.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R580;R683

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