Luo Yunhua, Yang Huijuan
Department of Mechanical Engineering, University of Manitoba, Winnipeg, Canada; Department of Biomedical Engineering, University of Manitoba, Winnipeg, Canada.
Department of Mechanical Engineering, University of Manitoba, Winnipeg, Canada.
Clin Biomech (Bristol). 2019 Mar;63:48-53. doi: 10.1016/j.clinbiomech.2019.02.016. Epub 2019 Feb 23.
BACKGROUND: Clinicians have been looking for a simple and effective biomechanical tool for the assessment of hip fracture risk. Dual-energy X-ray absorptiometry (DXA) is currently the primary bone imaging modality in clinic, and the engineering beam is the simplest model for a mechanical analysis. Therefore, we developed a DXA-based beam model for the above purpose. METHODS: A beam model of the proximal femur was constructed from the subject's hip DXA image and denoted DXA-beam. Femur stiffness was calculated at cross-sections of interest using areal bone-mineral-density profile. Impact force induced in a sideways fall was applied as a critical loading. Fracture risk index at a cross-section was defined as the ratio of strain-energy induced by the impact force to the allowable strain-energy. A clinic cohort was used to study the discriminability of DXA-beam, which was measured by the area under the curve and odds ratio, both with 95% confidential interval. FINDINGS: Fracture risk measured by DXA-beam model at the femoral neck [odds ratio 2.23, 95% confidence interval (1.83, 2.57)], inter-trochanter [2.49, (2.14, 3.25)] and sub-trochanter [2.82, (2.38, 3.51)] were strongly associated with hip fracture. The area under the curve by DXA-beam at the femoral neck [0.74, 95% confidence interval (0.70, 0.76)], inter-trochanter [0.77, (0.75, 0.82)] and sub-trochanter [0.76, (0.74, 0.81)] were higher than that by femoral neck bone mineral density [0.71, (0.65, 0.78)]. INTERPRETATION: The DXA-beam model is a simple and yet effective mechanical model. It had promising performance in discrimination of fracture cases from controls.
背景:临床医生一直在寻找一种简单有效的生物力学工具来评估髋部骨折风险。双能X线吸收法(DXA)是目前临床上主要的骨成像方式,而工程梁是力学分析中最简单的模型。因此,我们基于DXA开发了一种用于上述目的的梁模型。 方法:根据受试者的髋部DXA图像构建股骨近端的梁模型,并将其命名为DXA梁。使用面骨矿物质密度分布在感兴趣的横截面处计算股骨刚度。将侧方跌倒时产生的冲击力作为临界载荷施加。将横截面处的骨折风险指数定义为冲击力引起的应变能与允许应变能的比值。使用一个临床队列来研究DXA梁的辨别能力,通过曲线下面积和比值比进行测量,两者均具有95%的置信区间。 结果:通过DXA梁模型测量的股骨颈骨折风险[比值比2.23,95%置信区间(1.83,2.57)]、转子间骨折风险[2.49,(2.14,3.25)]和转子下骨折风险[2.82,(2.38,3.51)]与髋部骨折密切相关。DXA梁在股骨颈处的曲线下面积[0.74,95%置信区间(0.70,0.76)]、转子间[0.77,(0.75,0.82)]和转子下[0.76,(0.74,0.81)]高于股骨颈骨矿物质密度的曲线下面积[0.71,(0.65,0.78)]。 解读:DXA梁模型是一种简单而有效的力学模型。它在区分骨折病例和对照方面具有良好的性能。
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