截瘫患者骨质流失的影响因素。

Factors influencing bone loss in paraplegia.

作者信息

Dionyssiotis Y, Lyritis G P, Mavrogenis A F, Papagelopoulos P J

出版信息

Hippokratia. 2011 Jan;15(1):54-9.

DOI:

PMID:21607037

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3093146/

Abstract

BACKGROUND AND AIM

Significant bone loss develops in the first months and continues years after spinal cord injury. A cross - sectional comparative study was performed to evaluate factors influencing bone loss in spinal cord injured men with paraplegia.

PATIENTS AND METHODS

We studied 31 paraplegic men in chronic stage (>1.5 years) in comparison with 30 able-bodied men of similar age, height, and weight. The paraplegic men were allocated into 2 subgroups based on the neurological level of injury; high paraplegics (n=16, T4-T7 neurological level of injury) and low paraplegics (n=15, T8-T12 neurological level of injury). The influence of positive and negative factors (spasticity, standing-therapeutic walking, and duration of paralysis) on bone structures was evaluated by pQCT measurement of the total, trabecular and cortical bone mineral density (BMDtot, BMDtrab, BMDcort, respectively) and cortical thickness (THIcort) at the distal tibial epiphysis and the tibial diaphysis at 4% and 38% proximal to the distal end of the tibia. The stress strain index (SSI) was measured at 14% (SSI(2)) and at 38% (SSI(3)) of the tibial diaphysis, and the difference SSI(3) - SSI(2) (δSSI(3-2)) was calculated.

RESULTS

In all paraplegics, bone mineral density parameters were significantly reduced compared to the control group (BMDtot: p<0.0005, BMDtrab: p<0.0005, BMDcort: p=0.029, THIcort: p=0.019, SSI(2): p=0.009, SSI(3): p=0.003, respectively). Paraplegics who used standing frames or long brace orthoses had statistically significant higher bone mass and geometric parameters (BMDtrab: p=0.03, BMDtot: p=0.01, THIcort: p=0.013, respectively), while spasticity did not protect bone. The duration of paralysis was significantly related to trabecular bone loss (r=-0.5, p=0.05) and cortical thickness (r=-0.6, p=0.006) in high paraplegics and to δSSI(3-2) in low paraplegics (r=0.534, p=0.03).

CONCLUSIONS

The neurological level of injury adversely affects bone strength in paralyzed lower extremities such as the distal tibia. Standing or therapeutic walking could possibly have a positive effect in cortical and trabecular bone in paraplegia.

摘要

背景与目的

脊髓损伤后的最初几个月会出现显著的骨质流失，并会持续数年。本研究开展了一项横断面比较研究，以评估影响脊髓损伤截瘫男性骨质流失的因素。

患者与方法

我们研究了31例处于慢性期（>1.5年）的截瘫男性，并与30例年龄、身高和体重相似的健全男性进行比较。根据损伤的神经平面，将截瘫男性分为2个亚组；高位截瘫者（n = 16，T4 - T7神经损伤平面）和低位截瘫者（n = 15，T8 - T12神经损伤平面）。通过外周定量计算机断层扫描（pQCT）测量胫骨远端骨骺和距胫骨远端4%及38%处的胫骨骨干的总骨矿物质密度、小梁骨矿物质密度、皮质骨矿物质密度（分别为BMDtot、BMDtrab、BMDcort）以及皮质厚度（THIcort），评估正性和负性因素（痉挛、站立 - 治疗性步行和瘫痪持续时间）对骨结构的影响。在胫骨骨干的14%（SSI(2)）和38%（SSI(3)）处测量应力应变指数（SSI），并计算差值SSI(3) - SSI(2)（δSSI(3 - 2)）。

结果

与对照组相比，所有截瘫患者的骨矿物质密度参数均显著降低（BMDtot：p < 0.0005，BMDtrab：p < 0.0005，BMDcort：p = 0.029，THIcort：p = 0.019，SSI(2)：p = 0.009，SSI(3)：p = 0.003）。使用站立架或长支具矫形器的截瘫患者的骨量和几何参数在统计学上显著更高（BMDtrab：p = 0.03，BMDtot：p = 0.01，THIcort：p = 0.013），而痉挛对骨骼无保护作用。在高位截瘫患者中，瘫痪持续时间与小梁骨丢失（r = -0.5，p = 0.05）和皮质厚度（r = -0.6，p = 0.006）显著相关，在低位截瘫患者中与δSSI(3 - 2)显著相关（r = 0.534，p = 0.03）。