Lee Seung Yeol, Kwon Soon-Sun, Kim Tae Hoon, Shin Sang-Jin
Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, South Korea.
Department of Mathematics, College of Natural Science, Ajou University, Gyeonggi, South Korea.
Injury. 2016 Dec;47(12):2777-2782. doi: 10.1016/j.injury.2016.10.028. Epub 2016 Oct 27.
The objectives of this study were to evaluate the correlation between bone attenuation around the shoulder joint assessed on conventional computed tomography (CT) and bone mineral density (BMD) based on dual-energy X-ray absorptiometry (DEXA) of the central skeleton and the correlation between the bone quality around the shoulder joint and the severity of the fracture pattern of the proximal humerus.
A total of 200 patients with proximal humeral fracture who underwent preoperative 3-dimensional shoulder CT as well as DEXA within 3 months of the CT examination were included. Fracture types were divided into simple and comminuted fracture based on the Neer classification. After reliability testing, bone attenuation of the glenoid, three portions of the humeral head, and metaphysis was measured by placing a circular region of interest on the center of each bony region on CT images. Partial correlation analysis was used to assess the correlation between the bone quality around the shoulder joint on CT and the BMD on the central skeleton after adjusting for age and body mass index. Partial correlations between fracture classification and CT/DEXA results were also evaluated.
Bone attenuation measurements of the glenoid and humeral head showed good to excellent reliability (intraclass correlation coefficient, 0.623-0.998). Bone attenuation of the central portion of the humeral head on CT showed a significant correlation with the BMD of L1, L4, the femoral neck, and femoral trochanter (correlation coefficient, 0.269-0.431). Bone attenuation of other areas showed a lower correlation with BMD by DEXA. As the level of the Neer classification increased from a 2 to 4-part fracture, bone attenuation of the central humeral head decreased significantly (r=-0.150, p=0.034). However, the BMD on DEXA was not a predictive factor for comminuted fracture of the proximal humerus.
DEXA examination of the central skeleton may not reflect the bone quality of the proximal humerus and severity of proximal humeral fracture. Direct assessment of the bone quality of the proximal humerus is recommended to determine the osteoporotic nature of the fracture.
本研究的目的是评估基于传统计算机断层扫描（CT）评估的肩关节周围骨衰减与基于中央骨骼双能X线吸收法（DEXA）的骨密度（BMD）之间的相关性，以及肩关节周围骨质量与肱骨近端骨折模式严重程度之间的相关性。
纳入200例肱骨近端骨折患者，这些患者在术前接受了三维肩关节CT检查，并在CT检查后3个月内进行了DEXA检查。根据Neer分类，骨折类型分为简单骨折和粉碎性骨折。在可靠性测试后，通过在CT图像上每个骨区域的中心放置一个圆形感兴趣区域，测量肩胛盂、肱骨头的三个部分以及干骺端的骨衰减。采用偏相关分析来评估在调整年龄和体重指数后，CT上肩关节周围骨质量与中央骨骼BMD之间的相关性。还评估了骨折分类与CT/DEXA结果之间的偏相关性。
肩胛盂和肱骨头的骨衰减测量显示出良好至极好的可靠性（组内相关系数，0.623 - 0.998）。CT上肱骨头中央部分的骨衰减与L1、L4、股骨颈和股骨转子的BMD显著相关（相关系数，0.269 - 0.431）。其他区域的骨衰减与DEXA测量的BMD相关性较低。随着Neer分类从二部分骨折增加到四部分骨折，肱骨头中央的骨衰减显著降低（r = -0.150，p = 0.034）。然而，DEXA测量的BMD不是肱骨近端粉碎性骨折的预测因素。
对中央骨骼进行DEXA检查可能无法反映肱骨近端的骨质量和肱骨近端骨折的严重程度。建议直接评估肱骨近端的骨质量以确定骨折的骨质疏松性质。
