绝经后妇女定量CT法骨密度测量值与骨质疏松性脊柱脆性骨折相关性研究

覃浩然　覃海飚　李智斐　付拴虎　邓德茂　唐云　钟远鸣

【摘要】 目的 探讨定量CT法（QCT）骨密度（BMD）测量值与骨质疏松性脊柱脆性骨折相关性，寻找引起脆性骨折的BMD值的临界值范围。方法 对2016年6月至2018年3月住院的、第一次出现单个脊柱脆性骨折的80例绝经后妇女，应用64排CT测量患者T11～L4中未骨折椎体的QCT骨密度值进行分析;与同期80例自愿参与的符合纳入标准的无症状绝经后妇女 T11～L4椎体的QCT骨密度值进行对比分析。结果 试验组QCT骨密度值在35～50 mg/cm3区间的有63人，占78.75%;QCT骨密度值在50 mg/cm3以下的有69人，占86.25%，在50 mg/cm3以上的仅有11人，占13.75%;平均值为（43.63±7.54）mg/cm3。对照组QCT骨密度值在50～70 mg/cm3区间的有53人，占66.25%;QCT骨密度值在50 mg/cm3以上的有73人，占91.25%，在50 mg/cm3以下的只有7人，占8.75%;平均值为（64.57±12.07）mg/cm3。试验组与对照组的QCT骨密度平均值比较差异有统计学意义（t=13.158，P<0.001）。结论 绝经后有骨质疏松的妇女，当其QCT骨密度值降低到50 mg/cm3左右时极易出现骨质疏松性脆性骨折，QCT骨密度值50 mg/cm3很可能是引起脆性骨折的骨密度的臨界值。

【关键词】 骨质疏松;脆性骨折;骨密度;QCT;绝经后妇女

中图分类号：R683.2   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2019.06.005

【Abstract】 Objective To evaluate the correlation between the measured value of bone mineral density（BMD） measured by quantitative CT（QCT） and fragile fracture of osteoporotic spine，so as to find the critical value scope of BMD for fragile fracture.Methods 80 postmenopausal women who hospitalized from June 2016 to March 2018 with single fragile fracture of the spine for the first time were enrolled in this study.The values of BMD of QCT of non-fractured vertebrae in T11～L4 was measured by 64-slice CT and compared with those of 80 asymptomatic postmenopausal women who volunteered to participate and met the inclusion criteria in the same period.Results In the experimental group，63 cases（78.75%） had QCT bone mineral density in the range of 35～50 mg/cm3，69 cases（86.25%） had QCT bone mineral density below 50 mg/cm3，and only 11 cases（13.75%） had QCT bone mineral density above 50 mg/cm3.The average value was（43.63±7.54）mg/cm3.In the control group，53 cases（66.25%） had QCT bone mineral density in the range of 50～70mg/cm3，73 cases（91.25%） had QCT bone mineral density above 50 mg/cm3，and only 7 cases（8.75%） had QCT bone mineral density below 50 mg/cm3.The average value was（64.57±12.07）mg/cm3.The difference of the average value of QCT bone mineral density between the experimental group and the control group was statistically significant（t=13.158，P<0.001）.Conclusion Postmenopausal women with osteoporosis are prone to osteoporotic fragile fracture when their QCT bone mineral densities reduce to about 50 mg/cm3，and the QCT value of 50 mg/cm3 is likely to be the critical value of BMD for fragile fracture.

【Key words】 osteoporosis;fragile fracture;BMD;QCT;postmenopausal women

我国老龄化社会已经到来，骨质疏松性脊柱脆性骨折已经严重影响老年人的生活。老年骨质疏松症虽然遵循人体骨骼发育-成长-衰老的规律，也受激素的调控、营养状态、物理因素、免疫状况、遗传基因、生活方式、经济文化水平以及医疗保障的影响[1]。有相关资料表明，绝经后妇女约75%患有骨质疏松[2]。骨质疏松症所表现的慢性疼痛和导致的骨折及其他并发症严重影响老年人的寿命和生活质量，大大增加了相关的医疗费用[3～4]。目前诊断骨质疏松症仍以双能X线吸收法（DXA）的测定值作为金标准，定量CT法（QCT）用于诊断骨质疏松已经得到深入的研究，骨质疏松症引起脊柱脆性骨折与椎体体积骨密度（BMD）是否存在一个临界值？……