Marzolini S, McIlroy W, Tang A, Corbett D, Craven B C, Oh P I, Brooks D
University Health Network, Toronto Rehabilitation Institute, Toronto, Canada,
Osteoporos Int. 2014 Nov;25(11):2631-8. doi: 10.1007/s00198-014-2793-3. Epub 2014 Jul 8.
Risk of hip fracture is greater poststroke than in an age-matched healthy population, in part because of declining hip BMD. We found that individuals may be at risk of loss of hip BMD from muscle atrophy, asymmetrical gait, and poor affected-side ankle dorsiflexor strength. These impairments may be targeted during rehabilitation.
This study aimed to determine predictors of low hip BMD on the stroke-affected side in people living in the community.
Forty-three participants (female; 27.9%), mean age 62.4 ± 13.5 and 17.9 ± 32.8 months, poststroke with motor impairments underwent dual energy X-ray absorptiometry scans. Gait characteristics, isometric strength, body composition, and fasting plasma lipids were measured.
At entry, 34.9% (15/43) of the participants had low total hip BMD on the stroke-affected side. Of those with low BMD, 93.3% (14/15) had a step length symmetry ratio >1, indicating greater reliance on the non-paretic leg for weight bearing. Logistic regression analysis revealed that lower affected-side ankle dorsiflexor strength (ß = 0.700, p = 0.02), lower total body fat-free mass index (ß = 0.437, p = 0.02), and greater step length symmetry ratio during walking (ß = 1.135 × 10(3), p = 0.03) were predictors of low hip BMD.
Low BMD of the stroke-affected side hip is prevalent in over a third of individuals with lower limb motor impairments. These individuals may be at particular risk of accelerated loss of BMD at the hip from asymmetrical gait pattern and poor affected-side ankle dorsiflexor strength. These impairments are intervention targets that may be addressed during rehabilitation which includes resistance training and addresses gait impairments.
中风后髋部骨折的风险高于年龄匹配的健康人群，部分原因是髋部骨密度下降。我们发现，个体可能因肌肉萎缩、步态不对称以及患侧踝背屈肌力量差而面临髋部骨密度流失的风险。这些损伤在康复过程中可能成为治疗靶点。
本研究旨在确定社区中中风患者患侧髋部低骨密度的预测因素。
43名中风后有运动障碍的参与者（女性占27.9%），平均年龄62.4±13.5岁，中风后17.9±32.8个月，接受了双能X线吸收测定扫描。测量了步态特征、等长肌力、身体成分和空腹血脂。
入组时，34.9%（15/43）的参与者患侧髋部总骨密度较低。在骨密度低的参与者中，93.3%（14/15）的步长对称比>1，表明在负重时更依赖非瘫痪侧腿。逻辑回归分析显示，患侧踝背屈肌力量较低（β=0.700，p=0.02）、全身去脂体重指数较低（β=0.437，p=0.02）以及行走时步长对称比更大（β=1.135×10³，p=0.03）是髋部低骨密度的预测因素。
超过三分之一的下肢运动障碍患者患侧髋部骨密度较低。这些个体可能因步态不对称模式和患侧踝背屈肌力量差而特别面临髋部骨密度加速流失的风险。这些损伤是康复过程中的干预靶点，康复措施包括阻力训练和解决步态障碍问题。
