Leppälä J, Kannus P, Natri A, Pasanen M, Sievänen H, Vuori I, Järvinen M
Accident and Trauma Research Center, UKK Institute for Health Promotion Research, Tampere, Finland.
Calcif Tissue Int. 1999 Apr;64(4):357-63. doi: 10.1007/s002239900632.
The objective of this 1-year prospective follow-up study was to assess, with dual-energy X-ray absorptiometry (DXA), the effect of an anterior cruciate ligament (ACL) injury of the knee on areal bone mineral density (BMD) of the injured extremity and lumbar spine in two separate patient groups: 21 surgically treated patients (group A) and 12 conservatively treated patients (group B). Clinical and functional status of the patients and BMD of the spine (L2-L4), dominant distal radius, femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, and calcaneus of both lower extremities were determined at the time of the injury and after 4, 8, and 12 months. A surgically treated, complete ACL rupture (group A) resulted in considerable and statistically significant bone loss to the affected knee (distal femur 21%, patella 17%, proximal tibia 14%; P < 0.001 in each), whereas the other sites were clearly less affected. Patients with a conservatively treated, complete or partial ACL injury (group B) had only a small but statistically significant bone loss at the patella (-3%; P = 0.005) and proximal tibia (-2%; P = 0.022) of the injured knee, and the other sites remained unchanged. The obvious differences between the groups A and B in the severity of the injury itself (complete or partial tear), its treatment (surgical or conservative), and subsequent rehabilitation (longer nonweight-bearing times in group A) explain these different BMD results, and the forthcoming years will show whether the considerable posttraumatic osteoporosis in the affected knee of group A patients will finally recover, and if so, to what extent.
这项为期1年的前瞻性随访研究的目的是，通过双能X线吸收法（DXA），评估膝关节前交叉韧带（ACL）损伤对两个不同患者组中受伤肢体和腰椎的骨面积密度（BMD）的影响：21例接受手术治疗的患者（A组）和12例接受保守治疗的患者（B组）。在受伤时以及4、8和12个月后，测定患者的临床和功能状态以及脊柱（L2-L4）、优势侧桡骨远端、股骨颈、股骨转子区、股骨远端、髌骨、胫骨近端和双下肢跟骨的骨密度。手术治疗的完全性ACL断裂（A组）导致患侧膝关节出现显著且具有统计学意义的骨质流失（股骨远端21%、髌骨17%、胫骨近端14%；各部位P<0.001），而其他部位受影响明显较小。接受保守治疗的完全或部分ACL损伤患者（B组）仅在受伤膝关节的髌骨（-3%；P=0.005）和胫骨近端（-2%；P=0.022）出现少量但具有统计学意义的骨质流失，其他部位保持不变。A组和B组在损伤本身的严重程度（完全或部分撕裂）、治疗方式（手术或保守）以及后续康复情况（A组非负重时间更长）方面存在明显差异，这解释了不同的骨密度结果，未来几年将显示A组患者患侧膝关节明显的创伤后骨质疏松最终是否会恢复，以及如果恢复，恢复程度如何。
