[1]冯强强,王玲,程晓光,等.成人非创伤性股骨头坏死骨密度定量分析[J].中医正骨,2018,30(10):25-29.
　FENG Qiangqiang,WANG Ling,CHENG Xiaoguang,et al.Quantitative analysis of bone density of adults with non-traumatic femur head necrosis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):25-29.
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成人非创伤性股骨头坏死骨密度定量分析()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年10期
页码:
25-29
栏目:
股骨头坏死
出版日期:
2018-10-20

文章信息/Info

Title:
Quantitative analysis of bone density of adults with non-traumatic femur head necrosis
作者:
冯强强; 王玲; 程晓光; 郭晓忠
(北京积水潭医院,北京 100035)
Author(s):
FENG Qiangqiang; WANG Ling; CHENG Xiaoguang; GUO Xiaozhong
Beijing Jishuitan Hospital,Beijing 100035,China
关键词:
股骨头坏死;  骨密度;  定量CT
Keywords:
femur head necrosis;  bone density;  quantitative computerized tomography
摘要:
目的:探讨成人非创伤性股骨头坏死患者骨密度的特征。方法:收集2015年6月至2017年6月在北京积水潭医院行CT检查诊断为非创伤性股骨头坏死的患者(坏死组)。共31例48髋,男36髋、女12髋,年龄(47.42±15.29)岁,ARCO分期Ⅱ期21髋、Ⅲ期27髋。均无骨盆或髋关节外伤及手术史,未进行过药物干预。同时选取2015年6月至2017年6月因单侧髋关节骨折在北京积水潭医院行髋关节CT检查的患者(非坏死组)。共52例52髋,男38髋、女14髋,年龄(47.42±15.29)岁,对侧股骨均无异常。采用非同步定量CT测定坏死组股骨头坏死区、坏死周围区域、股骨颈、大转子、转子间的骨密度,测定非坏死组非骨折侧股骨头中心、股骨头边缘、股骨颈、大转子、转子间的骨密度,并对测得的数据做统计分析。结果:坏死组坏死区骨密度大于非坏死组股骨头中心骨密度[(348.44±78.77)mg·cm-3,(284.05±45.88)mg·cm-3,t=4.942,P=0.000]; 坏死组坏死周围区域骨密度大于非坏死组股骨头边缘骨密度[(218.59±47.82)mg·cm-3,(141.37±31.93)mg·cm-3,t=9.419,P=0.000]; 2组股骨颈、大转子、转子间骨密度比较,组间差异均无统计学意义[(98.63±58.43)mg·cm-3,(81.14±63.78)mg·cm-3,t=1.426,P=0.157;(45.38±37.15)mg·cm-3,(52.55±31.23)mg·cm-3,t=-1.048,P=0.297;(48.14±34.07)mg·cm-3,(45.37±42.60)mg·cm-3,t=0.357,P=0.722]。坏死组ARCOⅡ期坏死周围区域骨密度大于非坏死组股骨头边缘骨密度[(228.97±49.64)mg·cm-3,(141.37±31.93)mg·cm-3,t=7.486,P=0.000]; 坏死组ARCOⅡ期坏死区、股骨颈、大转子、转子间骨密度与非坏死组比较,组间差异均无统计学意义[(307.31±64.15)mg·cm-3,(284.05±45.88)mg·cm-3,t=1.513,P=0.141;(100.71±45.88)mg·cm-3,(81.14±63.78)mg·cm-3,t=1.277,P=0.206;(65.39±26.72)mg·cm-3,(52.55±31.23)mg·cm-3,t=1.653,P=0.103;(59.97±31.76)mg·cm-3,(45.37±42.60)mg·cm-3,t=1.417,P=0.161]。坏死组ARCOⅢ期坏死区骨密度大于非坏死组股骨头中心骨密度[(380.42±74.99)mg·cm-3,(284.05±45.88)mg·cm-3,t=6.110,P=0.000]; 坏死组ARCOⅢ期坏死周围区域骨密度大于非坏死组股骨头边缘骨密度[(210.52±45.64)mg·cm-3,(141.37±31.93)mg·cm-3,t=7.853,P=0.000]; 坏死组ARCOⅢ期大转子骨密度小于非坏死组[(29.81±37.03)mg·cm-3,(52.55±31.23)mg·cm-3,t=-2.879,P=0.005]; 坏死组ARCOⅢ期股骨颈、转子间骨密度与非坏死组比较,组间差异均无统计学意义[(97.01±67.43)mg·cm-3,(81.14±63.78)mg·cm-3,t=1.029,P=0.307;(38.94±33.49)mg·cm-3,(45.37±42.60)mg·cm-3,t=-0.682,P=0.497]。ARCOⅡ期坏死区骨密度小于ARCOⅢ期(t=-3.565,P=0.001),大转子、转子间骨密度均大于ARCOⅢ期(t=3.771,P=0.001; t=2.208,P=0.032); ARCOⅡ期坏死周围区域、股骨颈骨密度与ARCOⅢ期比较,差异均无统计学意义(t=1.337,P=0.188; t=0.225,P=0.823)。结论:股骨头坏死区和坏死周围区域骨密度较正常股骨头增高。
Abstract:
Objective:To explore the characteristics of bone density of adults with non-traumatic femur head necrosis(FHN).Methods:Thirty-one patients who were diagnosed as non-traumatic FHN(necrotic group)by computerized tomography(CT)examination in Beijing Jishuitan Hospital from June 2015 to June 2017 were collected.The patients(48 hips)consisted of males(36 hips)and females(12 hips),and ranged in age of 47.42+/-15.29 years,and the FHN belonged to ARCO phaseⅡ(21 hips)and ARCO phaseⅢ(27 hips).None of these patients had a history of trauma and surgery of pelvis or hip and received any drug intervention.Meanwhile,fifty-two patients who received hip CT examination for unilateral hip fracture(non-necrotic group)in Beijing Jishuitan Hospital from June 2015 to June 2017 were selected.The patients(52 hips)consisted of males(38 hips)and females(14 hips),and ranged in age of 47.42+/-15.29 years,and no abnormality was found in contralateral femur.The bone density of FHN area,FHN surrounding area,femoral neck,greater trochanter and intertrochanteric area of necrotic group and the bone density of center of femoral head,edge of femoral head,femoral neck,greater trochanter and intertrochanteric area of non-fractured side of non-necrotic group were determined by using non-synchronous quantitative CT,and then the measured data were statistically analyzed.Results:The bone density of FHN area of necrotic group was higher than that of center of femoral head of non-necrotic group(348.44+/-78.77 vs 284.05+/-45.88 mg/cm(-3),t=4.942,P=0.000).The bone density of FHN surrounding area of necrotic group was higher than that of edge of femoral head of non-necrotic group(218.59+/-47.82 vs 141.37+/-31.93 mg/cm(-3),t=9.419,P=0.000).There was no statistical difference in the bone density of femoral neck,greater trochanter and intertrochanteric area between the 2 groups(98.63+/-58.43 vs 81.14+/-63.78 mg/cm(-3),t=1.426,P=0.157; 45.38+/-37.15 vs 52.55+/-31.23 mg/cm(-3),t=-1.048,P=0.297; 48.14+/-34.07 vs 45.37+/-42.60 mg/cm(-3),t=0.357,P=0.722).The bone density of FHN surrounding area(ARCO phaseⅡ)of necrotic group was higher than that of edge of femoral head of non-necrotic group(228.97+/-49.64 vs 141.37+/-31.93 mg/cm(-3),t=7.486,P=0.000).There was no statistical difference in the bone density of FHN(ARCO phaseⅡ)area,femoral neck,greater trochanter and intertrochanteric area between necrotic group and non-necrotic group(307.31+/-64.15 vs 284.05+/-45.88 mg/cm(-3),t=1.513,P=0.141; 100.71+/-45.88 vs 81.14+/-63.78 mg/cm(-3),t=1.277,P=0.206; 65.39+/-26.72 vs 52.55+/-31.23 mg/cm(-3),t=1.653,P=0.103; 59.97+/-31.76 vs 45.37+/-42.60 mg/cm(-3),t=1.417,P=0.161).The bone density of FHN area(ARCO phaseⅢ)of necrotic group was higher than that of center of femoral head of non-necrotic group(380.42+/-74.99 vs 284.05+/-45.88 mg/cm(-3),t=6.110,P=0.000).The bone density of FHN(ARCO phaseⅢ)surrounding area of necrotic group was higher than that of edge of femoral head of non-necrotic group(210.52+/-45.64 vs 141.37+/-31.93 mg/cm(-3),t=7.853,P=0.000).The bone density of greater trochanter was lower in necrotic group(ARCO phaseⅢ)compared to non-necrotic group(29.81+/-37.03 vs 52.55+/-31.23 mg/cm(-3),t=-2.879,P=0.005).There was no statistical difference in the bone density of femoral neck and intertrochanteric area between necrotic group(ARCO phaseⅢ)and non-necrotic group(97.01+/-67.43 vs 81.14+/-63.78 mg/cm(-3),t=1.029,P=0.307; 38.94+/-33.49 vs 45.37+/-42.60 mg/cm(-3),t=-0.682,P=0.497).The bone density of FHN area was lower and the bone densities of greater trochanter and intertrochanteric area were higher in ARCO phaseⅡcompared to ARCO phaseⅢ(t=-3.565,P=0.001; t=3.771,P=0.001; t=2.208,P=0.032).There was no statistical difference in the bone density of FHN surrounding area and femoral neck between ARCO phaseⅡand ARCO phaseⅢ(t=1.337,P=0.188; t=0.225,P=0.823).Conclusion:The bone densities are higher in FHN area and FHN surrounding area compared to normal femoral head.

参考文献/References:


[1] 张崇耀,李峻辉,宁亚功.股骨头坏死发病机制探讨[J].中华临床医师杂志(电子版),2011,5(6):1705-1707.
[2] 刘铁钢,陈卫衡.非创伤性股骨头坏死的流行病学研究[J].当代医学,2008,14(20):64-65.
[3] ANN,DOROTHY,KING,et al.Magnetic resonance imaging staging of nasopharyngeal carcinoma in the head and neck[J].World J Radiol,2010,91(5):159-165.
[4] WENBAO,WANG,JEFFREY,et al.Longitudinal evaluation of time related femoral neck narrowing after metal-on-metal hip resurfacing[J].World J Orthop,2013,80(2):75-79.
[5] ZAINO CJ,LEALI A,FETTO JF.Bone density and mechanical properties in femoral bone of swim loaded aged mice[J].Clin Orthop Relat Res,2010,468(1):276-282.
[6] VANDE BERG BC,LECOUVET FE,KOUTAISSOFF S,et al.Bone marrow edema of the femoral head and transient osteoporosis of the hip[J].Eur J Radiol,2008,67(1):68-77.
[7] 赵凤朝,李子荣,张念非.不同病因股骨头坏死的病理改变[J].实用骨科杂志,2005,11(3):210-213.
[8] 郑云,贾乐,董都选,等.股骨头坏死20例组织病理学观察[J].诊断病理学杂志,2016,23(2):100-102.
[9] BROWN JK,TIMM W,BODEEN G,et al.Asynchronously Calibrated Quantitative Bone Densitometry[J].J Clin Densitom,2017,20(2):216-225.
[10] WANG L,SU Y,WANG Q,et al.Validation of asynchronous quantitative bone densitometry of the spine:Accuracy,short-term reproducibility,and a comparison with conventional quantitative computed tomography[J].Sci Rep,2017,7(1):6284.
[11] 蔡自强,闫培华,魏相磊,等.骨密度测量评价股骨头无菌坏死的应用研究[J].中华关节外科杂志( 电子版),2008,2(5):528-531.
[12] 周志强.骨密度测量在股骨头无菌坏死患者中的应用[J].临床研究,2016,24(1):119-120.
[13] 周斌,孙革,韩冬梅,等.成人股骨头缺血性坏死[J].风湿病与关节炎,2013,31(1):75-78.
[14] 赵德伟,胡永成.成人股骨头缺血性坏死[J].风湿病与关节炎,2013,36(1):75-78.
[15] JOINT SURGERY GROUP OF THE ORTHOPAEDIC BRANCH OF THE CHINESE MEDICAL ASSOCIATIPN.Guideline for diagnostic and treatment of osteonecrosis of the femoral head[J].Orthop Surg,2015,7(3):200-207.
[16] 康斌,唐诗添,杨衡,等.骨密度在股骨头缺血坏死后塌陷预测中的应用[J].实用骨科杂志,2009,1(1):30-32.
[17] MANN J,HOLDSTOCK G,HARMAN M,et al.Current concepts on osteonecrosis of the femoral head[J].World J Orthop,2015,13(8):590-601.

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通讯作者:郭晓忠 E-mail:guoxiaozhongemail@163.com
更新日期/Last Update: 2019-02-25