Lam F M H, Bui M, Yang F Z H, Pang M Y C
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Osteoporos Int. 2016 Feb;27(2):591-603. doi: 10.1007/s00198-015-3307-7. Epub 2015 Sep 2.
The study aimed to quantify the long-term effects of stroke on tibial bone morphology and hip bone density. Only the trabecular bone mineral density and bone strength index in the hemiparetic tibial distal epiphysis showed a significant decline among individuals who had sustained a stroke 12-24 months ago.
This study aims to determine the changes in bone density and morphology in lower limb long bones during a 1-year follow-up period and their relationship to muscle function in chronic stroke patients.
Twenty-eight chronic stroke patients (12-166 months after the acute stroke event at initial assessment) and 27 controls underwent bilateral scanning of the hip and tibia using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. Each subject was re-assessed 1 year after the initial assessment.
Twenty stroke cases and 23 controls completed all assessments. At the end of the follow-up, the paretic tibial distal epiphysis suffered significant decline in trabecular bone density (-1.8 ± 0.6 %, p = 0.006) and bone strength index (-2.7 ± 0.6 %, p < 0.001). More severe decline in the former was associated with poorer leg muscle strength (ρ = 0.447, p = 0.048) and motor recovery (ρ = 0.489, p = 0.029) measured at initial assessment. The loss in trabecular bone density remained significant among those whose stroke onset was 12-24 months ago (p < 0.001), but not among those whose stroke onset was beyond 24 months ago (p > 0.05) at the time of initial assessment. The changes of outcomes in the tibial diaphysis, except for cortical bone mineral content on the non-paretic side (-1.3 ± 0.3 %, p = 0.003), and hip bone density were well within the margin of error for precision.
There is evidence of continuous trabecular bone loss in the paretic tibial distal epiphysis among chronic stroke patients, but it tends to plateau after 2 years of stroke onset. The steady state may have been reached earlier in the hip and tibial diaphysis.
本研究旨在量化中风对胫骨骨形态和髋部骨密度的长期影响。在12 - 24个月前发生中风的个体中，仅偏瘫侧胫骨远端骨骺的小梁骨矿物质密度和骨强度指数出现显著下降。
本研究旨在确定慢性中风患者在1年随访期内下肢长骨骨密度和形态的变化及其与肌肉功能的关系。
28例慢性中风患者（初次评估时急性中风事件发生后12 - 166个月）和27例对照者分别使用双能X线吸收法和外周定量计算机断层扫描对髋部和胫骨进行双侧扫描。每位受试者在初次评估后1年进行重新评估。
20例中风患者和23例对照者完成了所有评估。随访结束时，偏瘫侧胫骨远端骨骺的小梁骨密度（-1.8±0.6%，p = 0.006）和骨强度指数（-2.7±0.6%，p < 0.001）显著下降。初次评估时，前者更严重的下降与较差的腿部肌肉力量（ρ = 0.447，p = 0.048）和运动恢复（ρ = 0.489，p = 0.029）相关。在初次评估时中风发作12 - 24个月的患者中，小梁骨密度的损失仍然显著（p < 0.001），但在中风发作超过24个月的患者中则不显著（p > 0.05）。胫骨骨干的结果变化，除了非偏瘫侧的皮质骨矿物质含量（-1.3±0.3%，p = 0.003）外，以及髋部骨密度均在精度误差范围内。
有证据表明慢性中风患者偏瘫侧胫骨远端骨骺存在持续的小梁骨丢失，但在中风发作2年后趋于平稳。髋部和胫骨骨干可能更早达到稳定状态。
