Iwamoto J, Tsukimura T, Takeda T
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
Am J Phys Med Rehabil. 1999 May-Jun;78(3):202-7. doi: 10.1097/00002060-199905000-00002.
The cortical bone mineral density (BMD) of the first metatarsus was measured using computed x-ray densitometry in 84 hemiplegic subjects (35 men and 49 postmenopausal women) and 49 healthy age-matched controls (23 men and 26 postmenopausal women), and the determinants of paralysis-induced cortical osteopenia were investigated. In the hemiplegia group, ages were 63.9 +/- 9.8 yr (mean +/- standard deviation) for men and 66.6 +/- 11.0 yr for women. The duration of hemiplegia was 25.3 +/- 19.8 mo for men and 26.0 +/- 26.3 mo for women. The Brunnstrom stage (lower limb) was 4.0 +/- 1.1 for men and 3.8 +/- 1.4 for women. The walking ability, evaluated by walking score, was 3.6 +/- 1.3 (range, 1-5) for men and 3.2 +/- 1.5 (range, 1-5) for women. The time since menopause was 14.8 +/- 10.0 yr. The age and time since menopause were similar in the hemiplegia and control groups. On the paralyzed side, the BMD of men and women in the hemiplegia group was significantly lower than that of the control group on the nondominant side (by 6.1% and 11.6%, respectively). In hemiplegic men, Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.418 and r = 0.349, respectively). In hemiplegic women, on the other hand, age, duration of hemiplegia, and years since menopause showed a significant negative correlation to the BMD (r = -0.260, r = -0.478, and r = -0.506, respectively), and Brunnstrom stage and walking score showed a significant positive correlation to the BMD (r = 0.526 and r = 0.406, respectively). These findings suggest that the determinant of metatarsal cortical BMD loss on the paralyzed side of the hemiplegic subject might be different according to gender. That is, although the degree of paralysis and walking ability could be a determinant of metatarsal cortical BMD loss on the paralyzed side of hemiplegic men, additional factors such as age, duration of hemiplegia, and years since menopause could play an important role in the determination of metatarsal cortical BMD loss in postmenopausal hemiplegic women.
采用计算机X线骨密度仪测量了84例偏瘫患者（35例男性和49例绝经后女性）以及49例年龄匹配的健康对照者（23例男性和26例绝经后女性）第一跖骨的皮质骨矿物质密度（BMD），并研究了瘫痪所致皮质骨减少的决定因素。在偏瘫组中，男性年龄为63.9±9.8岁（均值±标准差），女性为66.6±11.0岁。男性偏瘫持续时间为25.3±19.8个月，女性为26.0±26.3个月。男性Brunnstrom分期（下肢）为4.0±1.1，女性为3.8±1.4。通过步行评分评估的步行能力，男性为3.6±1.3（范围1 - 5），女性为3.2±1.5（范围1 - 5）。绝经时间为14.8±10.0年。偏瘫组和对照组的年龄及绝经时间相似。在偏瘫组中，男性和女性瘫痪侧的BMD均显著低于对照组非优势侧（分别低6.1%和11.6%）。在偏瘫男性中，Brunnstrom分期和步行评分与BMD呈显著正相关（分别为r = 0.418和r = 0.349）。另一方面，在偏瘫女性中，年龄、偏瘫持续时间和绝经后年限与BMD呈显著负相关（分别为r = -0.260、r = -0.478和r = -0.506），而Brunnstrom分期和步行评分与BMD呈显著正相关（分别为r = 0.526和r = 0.406）。这些发现表明，偏瘫患者瘫痪侧跖骨皮质BMD丢失的决定因素可能因性别而异。也就是说，虽然瘫痪程度和步行能力可能是偏瘫男性瘫痪侧跖骨皮质BMD丢失的决定因素，但年龄、偏瘫持续时间和绝经后年限等其他因素在绝经后偏瘫女性跖骨皮质BMD丢失的决定中可能起重要作用。
