Li Ning, Yuan Yi, Yin Lu, Yang Minghui, Liu Yandong, Zhang Wenshuang, Ma Kangkang, Zhou Fengyun, Cheng Zitong, Wang Ling, Cheng Xiaoguang
Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing 100035, China.
Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China.
Diagnostics (Basel). 2023 May 27;13(11):1877. doi: 10.3390/diagnostics13111877.
The aim of this study was to investigate whether site-specific differences in bone mineral density (BMD) of proximal femur correlate with the type of hip fracture using quantitative computed tomography. Femoral neck (FN) fractures were classified as nondisplaced or displaced subtypes. Intertrochanteric (IT) fractures were classified as A1, A2, or A3. The severe hip fractures were identified as displaced FN fractures or unstable IT fractures (A2 and A3). In total, 404 FN fractures (89 nondisplaced and 317 displaced) and 189 IT fractures (76 A1, 90 A2, and 23 A3) were enrolled. Areal BMD (aBMD) and volumetric BMD (vBMD) were measured in the regions of total hip (TH), trochanter (TR), FN, and IT of the contralateral unfractured femur. IT fractures exhibited lower BMD than FN fractures (all ≤ 0.01). However, unstable IT fractures had higher BMD compared with stable ones ( < 0.01). After adjusting for covariates, higher BMD in TH and IT were associated with IT A2 (A1 vs. A2: odds ratios (ORs) from 1.47 to 1.69, all < 0.01). Low bone measurements were risk factors for stable IT fractures (IT A1 vs. FN fracture subtypes: ORs from 0.40 to 0.65, all < 0.01). There are substantial site-specific differences in BMD between IT fractures A1 and displaced FN fractures. Higher bone density was associated with unstable IT fracture when compared with stable ones. The understanding of biomechanics of various fracture types could help to improve the clinical management of these patients.
本研究的目的是使用定量计算机断层扫描来调查股骨近端骨密度（BMD）的部位特异性差异是否与髋部骨折类型相关。股骨颈（FN）骨折分为无移位或移位亚型。转子间（IT）骨折分为A1、A2或A3型。严重髋部骨折被确定为移位的FN骨折或不稳定的IT骨折（A2和A3型）。总共纳入了404例FN骨折（89例无移位和317例移位）和189例IT骨折（76例A1型、90例A2型和23例A3型）。在对侧未骨折股骨的全髋（TH）、转子（TR）、FN和IT区域测量面积骨密度（aBMD）和体积骨密度（vBMD）。IT骨折的BMD低于FN骨折（均≤0.01）。然而，不稳定的IT骨折与稳定的IT骨折相比BMD更高（<0.01）。在调整协变量后，TH和IT区域较高的BMD与IT A2型相关（A1型与A2型：优势比（OR）为1.47至1.69，均<0.01）。低骨测量值是稳定IT骨折的危险因素（IT A1型与FN骨折亚型：OR为0.40至0.65，均<0.01）。IT骨折A1型和移位的FN骨折之间在BMD方面存在显著的部位特异性差异。与稳定的IT骨折相比，较高的骨密度与不稳定的IT骨折相关。了解各种骨折类型的生物力学有助于改善这些患者的临床管理。
