Neander G, Adolphson P, Hedström M, von Sivers K, Dahlborn M, Dalén N
Department of Orthopedics, Danderyd Hospital, Sweden.
Acta Orthop Scand. 1997 Oct;68(5):451-5. doi: 10.3109/17453679708996261.
We performed a prospective, longitudinal, quantitative computed tomography (QCT) study of bone mineral density (BMD), cortical bone volume, bone mass and muscle volume in 25 patients who were operated on with osteosynthesis because of a displaced femoral neck fracture. Both legs were scanned within 3 days after the fracture, and 3 and 6 months after the operation. The measurements were performed by a computer tomograph equipped for bone mineral densitometry. We found some side differences among the patients at the time of fracture, but none of the differences was statistically significant. After 6 months, we found reductions in BMD in the distal femur and proximal tibia on the fractured side of 11% and 19%, respectively, as well as a reduction in BMD of 7% in the proximal tibia on the uninjured side. We found no changes in cortical bone mass, either on the fractured femur or on the uninjured femur. The muscles of the thigh showed a loss of 9% on the fractured side, but a gain of 12% on the uninjured side. The findings of a bone loss in the distal femur and proximal tibia of the fractured leg and in the proximal tibia of the healthy leg, but no cortical bone loss in the middle femur on any side 6 months after the fracture, indicate that the cancellous bone is more sensitive to osteopenia. Moreover, this bone loss is interpreted as mainly a posttraumatic effect, since we also found a decrease in bone mineral on the uninjured side, despite a gain in muscle volume on that side, an overuse which was not sufficient to counteract the posttraumatic effect on the bone of the uninjured side.
我们对25例因股骨颈移位骨折接受接骨术的患者进行了一项前瞻性、纵向定量计算机断层扫描（QCT）研究，以评估骨密度（BMD）、皮质骨体积、骨量和肌肉体积。在骨折后3天内以及术后3个月和6个月对双腿进行扫描。测量由配备骨密度测定功能的计算机断层扫描仪完成。我们发现骨折时患者之间存在一些双侧差异，但没有一个差异具有统计学意义。6个月后，我们发现骨折侧股骨远端和胫骨近端的骨密度分别降低了11%和19%，未受伤侧胫骨近端的骨密度也降低了7%。我们发现骨折侧股骨和未受伤侧股骨的皮质骨量均无变化。大腿肌肉在骨折侧减少了9%，但在未受伤侧增加了12%。骨折后6个月，骨折侧股骨远端和胫骨近端以及健康侧胫骨近端出现骨丢失，但任何一侧股骨中段均无皮质骨丢失，这一发现表明松质骨对骨质减少更为敏感。此外，这种骨丢失主要被解释为创伤后效应，因为我们还发现未受伤侧尽管肌肉体积增加，但骨矿物质仍减少，这种过度使用不足以抵消创伤对未受伤侧骨骼的影响。
