Lazoura Olga, Groumas Nikos, Antoniadou Eleftheria, Papadaki Paraskevi J, Papadimitriou Alexandros, Thriskos Paschalis, Fezoulidis Ioannis, Vlychou Marianna
Department of Radiology, National Rehabilitation Centre, Athens, Greece.
J Clin Densitom. 2008 Oct-Dec;11(4):511-7. doi: 10.1016/j.jocd.2008.05.097. Epub 2008 Jul 18.
To evaluate the loss of trabecular and cortical bone mineral density (BMD) and geometric parameters of bone strength expressed by stress-strain index (SSI) in the proximal and distal forearm and the alterations of BMD in the hip of hemiplegic patient and 12 mo after stroke. Sixty-seven hemiplegic patients (43 men and 24 women) with a history of single completed strokes associated with unilateral weakness were enrolled in this prospective study. All patients underwent bone densitometry measurements at 3, 6, and 12 mo after the initial episode of stroke. Both paretic and normal forearms were examined by peripheral quantitative computed tomography (pQCT) at the 4% and 20% sites of the forearm length and both hips were examined by dual-energy X-ray absorptiometry (DXA) including the area of femoral neck and greater trochanter. The diagnosis of stroke was confirmed by cranial computed tomography. Motor function was assessed by the functional ambulation category (FAC) and spasticity by the modified Ashworth scale (MAS). We found statistically significant trabecular and cortical bone density reductions during the course of our study in the forearm, which was more profound on the paretic side. Trabecular bone loss and SSI measured at 4% of the paretic forearm in the male group represented a 12-mo decrease of 14.01% and 28.61%, respectively, and in the female group 9.29% and 19.17%, respectively. Cortical bone and SSI measured at the 20% site of paretic forearm in the male group corresponded to a 12-mo decrease of 4.02% and 7.43%, respectively, and in the female group 2.59% and 6.97%, respectively. Paretic femoral neck and trochanter measurements in males showed a reduction of 11.76% and 10.38%, respectively, and in females 13.04% and 12.6%, respectively. A significant loss of BMD and bone strength was found during the first year after stroke in both trabecular and cortical bone at the forearm and at the neck and great trochanter on the paretic hip. Most prominent BMD reduction was evident in men compared with perimenopausal women in the same age.
评估偏瘫患者在中风后即刻及12个月时，前臂近端和远端的小梁骨和皮质骨矿物质密度（BMD）损失以及用应力应变指数（SSI）表示的骨强度几何参数，以及髋部BMD的变化。本前瞻性研究纳入了67例有单次完全性中风病史且伴有单侧肢体无力的偏瘫患者（43例男性和24例女性）。所有患者在中风初次发作后的3、6和12个月接受骨密度测量。患侧和正常前臂均通过外周定量计算机断层扫描（pQCT）在前臂长度的4%和20%部位进行检查，双侧髋部均通过双能X线吸收法（DXA）检查，包括股骨颈和大转子区域。中风诊断通过头颅计算机断层扫描确认。运动功能通过功能步行分类（FAC）评估，痉挛程度通过改良Ashworth量表（MAS）评估。我们发现在研究过程中，前臂的小梁骨和皮质骨密度有统计学意义的降低，患侧更为明显。男性组患侧前臂4%处的小梁骨丢失和SSI在12个月内分别下降了14.01%和28.61%，女性组分别下降了9.29%和19.17%。男性组患侧前臂20%部位的皮质骨和SSI在12个月内分别下降了4.02%和7.43%，女性组分别下降了2.59%和6.97%。男性患侧股骨颈和转子的测量值分别下降了11.76%和10.38%，女性分别下降了13.04%和12.6%。在中风后的第一年，患侧前臂的小梁骨和皮质骨以及患侧髋部的股骨颈和大转子处的BMD和骨强度均有显著损失。与同年龄围绝经期女性相比，男性的BMD降低最为明显。
