Sakai Akinori, Oshige Toshihisa, Zenke Yukichi, Suzuki Masahiro, Yamanaka Yoshiaki, Nakamura Toshitaka
Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
J Hand Surg Am. 2008 Jul-Aug;33(6):820-6. doi: 10.1016/j.jhsa.2008.02.014.
To investigate whether the degree of radiographically observed pretreatment radius deformity of low-energy Colles' type distal radius fractures resulting from falls is associated with the degree of bone fragility as measured by bone mineral density (BMD) of the lumbar spine in Japanese women above 50 years of age.
The study subjects were 125 consecutive Japanese women older than 50 years of age with Colles' type (AO type A and C) dorsally angulated distal radius fractures caused by falls. Fractures due to high-energy injuries such as traffic accidents were excluded. Radius deformity was assessed on anteroposterior and lateral radiographs by measuring ulnar variance, radial inclination, and dorsal angulation at initial examination before manual repositioning of the bone. Bone mineral density of the lumbar spine was also measured by dual energy x-ray absorptiometry at the follow-up visit.
There were significant differences in the respective values of ulnar variance, radial inclination, and dorsal angulation between patients with BMD values < 70% of the mean value of young adults and those with BMD values > or = 70%. Radius deformity was significantly greater for all parameters in the former group relative to the latter. The respective values of increased ulnar variance, decreased radial inclination, and increased dorsal angulation significantly correlated with lower BMD. Stepwise regression analysis of data of all subjects identified that ulnar variance was significantly associated with dorsal angulation, BMD, and radial inclination. The addition of body height, body weight, body mass index, and urinary type I collagen cross-linked N-telopeptides (bone resorption marker) to the regression analysis of data of a subset of patients confirmed that ulnar variance was significantly associated with BMD and radial inclination.
There is a significant association between BMD of the lumbar spine and radiographic radius deformity seen in low-energy Colles' type distal radius fractures resulting from falls in Japanese women above 50 years of age.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic I.
探讨50岁以上日本女性因跌倒导致的低能量Colles型桡骨远端骨折，影像学观察到的治疗前桡骨畸形程度与通过腰椎骨密度（BMD）测量的骨脆性程度之间是否存在关联。
研究对象为125例连续的50岁以上日本女性，她们因跌倒导致Colles型（AO A型和C型）桡骨远端背侧成角骨折。排除交通事故等高能量损伤导致的骨折。在手动复位前的初次检查时，通过测量尺骨变异、桡骨倾斜度和背侧成角，在前后位和侧位X线片上评估桡骨畸形。在随访时也通过双能X线吸收法测量腰椎骨密度。
骨密度值低于年轻成年人平均值70%的患者与骨密度值大于或等于70%的患者相比，尺骨变异、桡骨倾斜度和背侧成角的各自值存在显著差异。相对于后者，前一组所有参数的桡骨畸形明显更大。尺骨变异增加、桡骨倾斜度降低和背侧成角增加的各自值与较低的骨密度显著相关。对所有受试者的数据进行逐步回归分析发现，尺骨变异与背侧成角、骨密度和桡骨倾斜度显著相关。在一部分患者的数据回归分析中加入身高、体重、体重指数和尿I型胶原交联N-端肽（骨吸收标志物）后，证实尺骨变异与骨密度和桡骨倾斜度显著相关。
50岁以上日本女性因跌倒导致的低能量Colles型桡骨远端骨折中，腰椎骨密度与影像学桡骨畸形之间存在显著关联。
研究类型/证据水平：预后I级。
