Leppälä J, Kannus P, Natri A, Sievänen H, Järvinen M, Vuori I
Accident and Trauma Research Center, UKK Institute for Health Promotion Research, Tampere, Finland.
Calcif Tissue Int. 1998 Jun;62(6):548-53. doi: 10.1007/s002239900477.
Bone mineral density (BMD) and clinical status of 40 patients with a chronic, unilateral patellofemoral pain syndrome (PFPS) were determinated. The mean duration of the disease at the time of the follow-up was 7.6 +/- 1.8 (SD) years. The BMD was measured at the spine (L2-L4), and the femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, and calcaneus of both lower extremities using a dual-energy X-ray absorptiometric (DXA) scanner. The mean BMD of the affected limb (compared with the unaffected side) was significantly lower in the distal femur (-3.3%; P = 0.002), patella (-2.5%; P = 0.016), and proximal tibia (-1.9%; P = 0.008). The femoral neck, trochanter area of the femur, and calcaneus showed no significant side-to-side differences, and the spinal BMDs of men and women with the PFPS were comparable with the manufacturer's age-adjusted reference values for Western European men and women. The relative BMDs of the affected knee showed strongest correlation with the muscle strength of the same knee: the better the muscle strength compared with the healthy knee, the higher the relative BMD (r = 0.56-0.58 with P < 0.001 in each anatomic site of the knee). In the stepwise regression analysis, low body weight or low body mass index, high level of physical activity, the patient's good subjective overall assessment of his/her affected knee, and short duration of the symptoms were also independent predictors of the high relative BMD in the affected knee so that along with the muscle strength these variables could account for 51% of the variation seen in the relative BMD of the femur, 61% in the patella, and 54% in the proximal tibia. In conclusion, chronic patellofemoral pain syndrome results in a significantly decreased BMD in the knee region of the affected limb. The spine, proximal femur, and calcaneus are not affected. Recovery of normal muscle strength and knee function seems to be of great importance for good BMD.
测定了40例慢性单侧髌股关节疼痛综合征（PFPS）患者的骨密度（BMD）和临床状况。随访时疾病的平均持续时间为7.6±1.8（标准差）年。使用双能X线吸收测定法（DXA）扫描仪测量脊柱（L2-L4）、双侧下肢的股骨颈、股骨转子区、股骨远端、髌骨、胫骨近端和跟骨的骨密度。患侧肢体（与未受影响侧相比）的平均骨密度在股骨远端（-3.3%；P=0.002）、髌骨（-2.5%；P=0.016）和胫骨近端（-1.9%；P=0.008）显著降低。股骨颈、股骨转子区和跟骨未显示出显著的左右差异，PFPS男性和女性的脊柱骨密度与制造商针对西欧男性和女性的年龄校正参考值相当。患侧膝关节的相对骨密度与同一膝关节的肌肉力量相关性最强：与健康膝关节相比肌肉力量越好，相对骨密度越高（膝关节各解剖部位r=0.56-0.58，P<0.001）。在逐步回归分析中，低体重或低体重指数、高水平的体力活动、患者对患侧膝关节的良好主观总体评估以及症状持续时间短也是患侧膝关节相对骨密度高的独立预测因素，因此这些变量与肌肉力量一起可解释股骨相对骨密度变化的51%、髌骨的61%和胫骨近端的54%。总之，慢性髌股关节疼痛综合征导致患侧肢体膝关节区域的骨密度显著降低。脊柱、股骨近端和跟骨未受影响。恢复正常肌肉力量和膝关节功能似乎对良好的骨密度非常重要。
