Clayton Robert A E, Gaston Mark S, Ralston Stuart H, Court-Brown Charles M, McQueen Margaret M
Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, United Kingdom.
J Bone Joint Surg Am. 2009 Mar 1;91(3):613-9. doi: 10.2106/JBJS.H.00486.
The role of osteoporosis and osteopenia in the etiology of fractures of the distal part of the radius is well established, but any link between osteoporosis and the severity of the distal radial fracture has not been extensively investigated. The aim of this study was to investigate the association between the degree of osteoporosis and the severity of distal radial fractures.
All patients over fifty-five years of age with a low-energy distal radial fracture were offered dual x-ray absorptiometry scanning of the hip. Data on the 137 consecutive patients were collected prospectively. Plain radiographs of the fractured distal part of the radius were assessed for angulation, metaphyseal and articular comminution, carpal malalignment, ulnar variance, AO/OTA group and subgroup classification, early and late displacement, and malunion. Fracture severity was quantified with use of previously published algorithms for calculating the probability of early and late displacement, late carpal malalignment, and malunion. These severity scores were correlated with the dual x-ray absorptiometry T-scores, which represent the number of standard deviations by which the measured bone density differs from the mean value in healthy controls.
There was a significant linear correlation between increasingly negative T-scores and increasing likelihood of early instability, late carpal malalignment, and malunion. Patients with osteoporosis (a T-score of less than -2.5) had a 43% probability of having early instability, a 39% probability of having late carpal malalignment, and a 66% probability of having malunion. Patients with osteopenia (a T-score of more than -2.5 but less than -1) had a 35% probability of having early instability, a 31% probability of having late carpal malalignment, and a 56% probability of having malunion. This compared with a 28% probability of early instability, a 25% probability of late carpal malalignment, and a 48% probability of malunion in patients with normal bone mineral density (a T-score of more than -1).
There is a definite correlation between bone mineral density and the severity of distal radial fractures.
骨质疏松和骨量减少在桡骨远端骨折病因中的作用已得到充分证实，但骨质疏松与桡骨远端骨折严重程度之间的任何关联尚未得到广泛研究。本研究的目的是调查骨质疏松程度与桡骨远端骨折严重程度之间的关联。
所有55岁以上的低能量桡骨远端骨折患者均接受了髋部双能X线吸收测定扫描。前瞻性收集了137例连续患者的数据。对桡骨远端骨折部位的X线平片进行评估，包括成角、干骺端和关节粉碎、腕骨排列不齐、尺骨变异、AO/OTA组和亚组分类、早期和晚期移位以及畸形愈合。使用先前发表的算法计算早期和晚期移位、晚期腕骨排列不齐和畸形愈合的概率，对骨折严重程度进行量化。这些严重程度评分与双能X线吸收测定T值相关，T值表示测量的骨密度与健康对照平均值相差的标准差数量。
T值越来越负与早期不稳定、晚期腕骨排列不齐和畸形愈合的可能性增加之间存在显著的线性相关性。骨质疏松患者（T值小于-2.5）发生早期不稳定的概率为43%，发生晚期腕骨排列不齐的概率为39%，发生畸形愈合的概率为66%。骨量减少患者（T值大于-2.5但小于-1）发生早期不稳定的概率为35%，发生晚期腕骨排列不齐的概率为31%，发生畸形愈合的概率为56%。相比之下，骨密度正常患者（T值大于-1）发生早期不稳定的概率为28%，发生晚期腕骨排列不齐的概率为25%，发生畸形愈合的概率为48%。
骨密度与桡骨远端骨折的严重程度之间存在明确的相关性。
