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阮建萍,李冠武,汤光宇,等.DXA髋几何力学参数评估女性股骨近端强度[J].同济大学学报（医学版）,2014,35(1):46-51. [点击复制]
RUAN Jian-ping,LI Guan-wu,TANG Guan-yu,et al.Evaluation of hip bone strength in healthy women by dual energy X-ray absorptiometry[J].同济大学学报（医学版）,2014,35(1):46-51. [点击复制]

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DXA髋几何力学参数评估女性股骨近端强度
阮建萍²,李冠武²,汤光宇¹,邵泓达¹,刘勇¹,赵文荣¹
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(2.上海中医药大学附属岳阳中西医结合医院放射科,上海200437;1.同济大学附属第十人民医院放射科，上海200072)

摘要:

目的探讨基于双能X线吸收测量法的女性人群髋几何力学参数的变化规律。方法健康女性259例 (年龄28.2 ~88.3岁）行DXA扫描获取股骨颈骨密度（femur neck BMD, FN_BMD)及髋几何力学参数，包括：股骨领横截面惯性矩（cross-sectional moment of inertia, CSMI)、股骨领横截面面积（cross-sectional area, CSA)、截面模数（section modulus, SM)、曲率比率（buckling ratio, BR)、颈宽度（femur neck width，FNW )、號轴长（hip axis length, HAL)、颈千角（neck shaft angle, NSA),并计算股骨颈强度指数（femur strength index, FSI),分析競几何力学参数在不同骨量组间的差异，多元线性回归模型分析髋几何参数对FN_BMD的影响。结果髋几何力学参数 FSI、SM、CSMI、CSA随着骨量减少呈降低趋势，而BR、FNW、NSA、HAL参数随着骨量减少呈增大趋势。校正年龄、身高、体质量、BMI后，不同骨量组间髋几何强度参数存在差异（P均<0.05)。FN_BMD、体测指标与髋几何力学参数以及各髋几何力学参数间存在相关性（P均<0.05)。多元线性回归分析,FSI (标准回归系数艰=0.335)、 CSA(sβ=0.269)、SM(sβ=0.132)、FNW(sβ=-0.080)是 FN_BMD 重要影响因素（P均 <0.001),该模型能够解释FN_BMD变化的92.6%。结论骨量丢失与髋结构重塑同步，共同导致髋强度下降。髋几何力学参数是评估髋部骨强度的有用因子。

关键词: 双能X线吸收测量法骨密度髋结构分析

DOI：10.3969/j.issnl008-0392.2014.01.010

基金项目:国家自然科学基金（81071134)

Evaluation of hip bone strength in healthy women by dual energy X-ray absorptiometry

RUAN Jian-ping²,LI Guan-wu²,TANG Guan-yu¹,SHAO Hong-da¹,LIU Yong¹,ZHAO Wen-rong¹

(2. Dept. of Radiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437，China;1. Dept. of Radiology, Tenth People's Hospital, Tongji University, Shanghai 200072, China)

Abstract:

Objective To measure hip structural geometry parameters by dual energy X-ray absorptiometry (DXA) in healthy female subjects. Methods Two hundred and fifty nine healthy women aged 28-88 were measured by DXA to obtain femoral neck bone mineral density (FN-BMD) and proximal femur geometry parameters, including cross-sectional moment of inertia (CSMI)，cross-sectional area (CSA)，section modulus (SM), buckling ratio (BR)，femur neck width (FNW)，hip axis length (HAL),neck shaft angle (NSA) and femur strength index (FSI) ). Correlation analyses between anthropometries, FN-BMD and hip structural parameters were performed with Pearson's correlation analysis and partial correlation analysis. Stepwise linear regression analysis was performed to evaluate the relationship between FN-BMD and hip structural parameters. Results Hip structural parameters FSI, SM, CSMI，CSA decreased while BR，FNW, NSA, HAL increased with the reduction of bone mass. There were significant differences in indices of hip bone strength among normal bone mass, osteopenia and osteoporosis (all P<0.05). There were significant correlations of hip structural geometric properties with FN-BMD and anthropometries (age, height, weight and BMI) (all P<0.05). In a forward stepwise regression model，FSI (sβ=0.335)，CSA (sβ=0.269)，SM (sβ=0.132 ) , FNW (sβ=-0.080) were significant predictors of FN-BMD (all P<0.01)，which explained 92. 6% of the variability of FN-BMD after adjusting for age, height, weight and BMI. Conclusion Bone loss occurs in synchrony with remodeling of hip bone structure, both of which lead to decreased hip bone strength. Proximal femur geometry may be valuable in the assessment of bone fragility independent of FN-BMD

Key words: dual energy X-ray absorptiometry bone mineral density hip structure analysis