髋部结构分析在预测髋部脆性骨折的意义

发布时间：2018-04-13 08:52

本文选题：骨质疏松 + 脆性骨折　；参考：《中国医学物理学杂志》2017年05期

【摘要】：目的:探讨绝经后女性髋部结构几何力学参数在预测髋部脆性骨折危险性的临床意义。方法:选取216例绝经后女性,其中髋部骨折70例,正常对照组146例,测量股骨颈骨密度(FN-BMD),并用髋结构分析(HSA)软件在DXA扫描图像上分析得出髋结构几何力学参数,包括截面弯曲模量(SEM)、股骨颈横截面转动惯量(CSMI)、股骨颈横截面积(CSA)、屈曲应力比(BR)、股骨颈的皮质骨厚度(FNCT)及股骨颈干角(NSA)。利用ROC曲线分别分析其预测髋部骨折的效能。结果:FN-BMD、CSA、CSMI、FNCT、SEM在骨折组低于对照组(P0.05),年龄、BR在骨折组高于对照组(P0.05)。Logistic回归分析。年龄、BMI、FN-BMD、CSA、CSMI、FNCT、SEM、BR影响骨折发生的因素,得出FN-BMD、FNCT是判定绝经后妇女髋部脆性骨折最相关的危险因素。FN-BMD、CSA、CSMI、FNCT、SEM与年龄呈负相关,CSA、SEM与FN-BMD呈显著正相关(r分别为0.945、0.763,P0.001),BR与FN-BMD呈显著负相关(r=-0.854,P0.001),与年龄呈中度正相关。NSA角与年龄、绝经年龄、FN-BMD无相关性。通过ROC曲线分析髋关节几何学参数、FN-BMD及二者联合预测髋部骨折准确度,发现髋关节几何学参数联合FN-BMD的ROC曲线下面积为0.860(P=0.000),高于FN-BMD及髋关节几何学参数单独对脆性骨折的预测,并且曲线下面积差异存在统计学意义(P0.05)。结论:(1)绝经后妇女的髋部骨强度不仅与骨量丢失相关,还与几何力学空间因素改变相关,故临床预测髋部脆性骨折应考虑FN-BMD及髋几何结构参数;(2)髋结构分析联合FN-BMD测定可以提高髋部脆性骨折风险的预测水平。
[Abstract]:Objective: to investigate the clinical significance of postmenopausal hip structure geometric mechanical parameters in predicting the risk of fragile hip fracture.Methods: a total of 216 postmenopausal women, including 70 hip fractures and 146 normal controls, were selected to measure the bone mineral density of femoral neck (FN-BMDN) and to obtain the geometrical mechanical parameters of hip structure on DXA scanning images.These include the bending modulus of the femoral neck, the moment of inertia of the cross section of the femoral neck, the cross sectional area of the femoral neck, the flexion stress ratio (BRN), the cortical bone thickness of the femoral neck, and the angle of the femoral neck.The effectiveness of ROC curve in predicting hip fracture was analyzed.Results the percentage of FNCTSEM in the fracture group was lower than that in the control group (P 0.05), and the age of Br in the fracture group was higher than that in the control group (P 0.05).Age of BMIA FN-BMDA CSAC CSMIA FNCTA SEMBR influence factors of fracture,There was no correlation between FN-BMD and menopausal age.The accuracy of hip fracture prediction was analyzed by ROC curve and the combination of FN-BMD and FN-BMD. It was found that the area under the ROC curve of hip geometry parameter combined with FN-BMD was 0.860 P0. 000, which was higher than that of FN-BMD and hip geometry parameters alone in predicting brittle fracture.The difference of area under the curve was statistically significant (P 0.05).Conclusion the hip bone strength of postmenopausal women is related not only to bone loss, but also to the spatial change of geometric mechanics.Therefore, the clinical prediction of fragile hip fracture should consider FN-BMD and hip geometric structure parameters. The hip structure analysis combined with FN-BMD measurement can improve the prediction level of the risk of fragile hip fracture.
【作者单位】：福建医科大学附属第二医院;泉州医学高等专科学校;
【基金】：泉州市科技局社会发展计划重点资助项目(2013Z106)
【分类号】：R580;R683

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