本文選題：骨質(zhì)疏松　切入點(diǎn)：甲狀旁腺激素　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:了解脊柱骨疏骨折中骨密度值和骨代謝生化指標(biāo)的狀況,探索骨密度及骨代謝在脊柱骨質(zhì)疏松性骨折中的應(yīng)用價(jià)值,以期為脊柱骨質(zhì)疏松骨折提供完善的診斷及治療策略。方法:依據(jù)納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)搜集2015年1月~2016年1月期間就診于寧夏人民醫(yī)院脊柱骨科,發(fā)生脆性脊柱骨折的60歲以上老年患者共60例作為研究對(duì)象,所有入選患者均常規(guī)行胸腰段X線、CT及MRI檢查,然后檢測(cè)各患者的腰椎(L1-L4)和雙側(cè)髖部骨密度,并依據(jù)測(cè)得的骨密度值分組,任一部位的T值評(píng)分-2.5即為非骨質(zhì)疏松組,任一部位的T值評(píng)分≤-2.5即為骨質(zhì)疏松組。骨質(zhì)疏松組共34例,其中男性14例,女性20例,女性患者均為絕經(jīng)后婦女,年齡為61-85歲,平均年齡為70歲。非骨質(zhì)疏松組共26例,其中男性9例,女性17例,女性均為絕經(jīng)后婦女,年齡為60-86歲,平均年齡為68.7歲,兩組間的年齡經(jīng)對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義,具有可比性。記錄各組患者的堿性磷酸酶(ALP),骨鈣素(BGP),甲狀旁腺激素(PTH),25羥維生素D(25-OH-VD)等骨代謝生化指標(biāo)以及觀察X線、CT及MRI等影像學(xué)表現(xiàn)。依據(jù)Oswestry功能障礙指數(shù)評(píng)分表(Oswestry dysfunction index ODI)、Wong-Banker面部表情量表法(FPS-R)對(duì)60例脆性骨折患者的臨床癥狀進(jìn)行量化評(píng)估,然后對(duì)比分析兩組間骨代謝生化指標(biāo)變化情況以及臨床表現(xiàn)狀況,以及統(tǒng)計(jì)分析骨密度的檢測(cè)部位與年齡的關(guān)系、不同標(biāo)準(zhǔn)下的骨質(zhì)疏松檢出率的差異,并探討發(fā)生脆性骨折患者中骨密度值卻未達(dá)到骨質(zhì)疏松的可能原因。結(jié)果:兩組間患者年齡、性別的比較結(jié)果:兩組間患者的年齡、性別對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩組間具有可比性;兩組間四種骨代謝指標(biāo)的對(duì)比結(jié)果:發(fā)生脆性骨折的脊柱骨折患者中,依據(jù)骨密度分為非骨質(zhì)疏松組中的甲狀旁腺激素含量、骨鈣素含量、25-羥基維生素D及堿性磷酸酶與骨質(zhì)疏松組無(wú)統(tǒng)計(jì)學(xué)意義;非骨質(zhì)疏松組與骨質(zhì)疏松組ODI指數(shù)評(píng)分對(duì)比結(jié)果:非骨質(zhì)疏松組ODI指數(shù)評(píng)分平均57.90分,骨質(zhì)疏松組ODI指數(shù)評(píng)分平均59.67分,兩組間ODI指數(shù)評(píng)分對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義;非骨質(zhì)疏松組與骨質(zhì)疏松組FPS-R評(píng)分對(duì)比結(jié)果:非骨質(zhì)疏松組FPS-R評(píng)分平均(7.5±0.5)分,骨質(zhì)疏松組FPS-R評(píng)分平均(7.9±0.7)分,兩組間FPS-R評(píng)分對(duì)比無(wú)統(tǒng)計(jì)學(xué)意義;最低T值評(píng)分在不同部位檢出的患者年齡比較結(jié)果:骨密度的最低T值評(píng)分出現(xiàn)在腰椎的患者平均年齡65歲,骨密度的最低T值評(píng)分出現(xiàn)在髖部的患者平均年齡73歲,差異有統(tǒng)計(jì)學(xué)意義;不同判定標(biāo)準(zhǔn)下的骨質(zhì)疏松檢出率比較結(jié)果:以2.0SD為診斷標(biāo)準(zhǔn)的骨質(zhì)疏松檢出率為75%,以2.5SD為診斷標(biāo)準(zhǔn)的骨質(zhì)疏松檢出率為50%,差異有統(tǒng)計(jì)學(xué)意義;60例脆性脊柱骨折患者在影像學(xué)表現(xiàn):均可見(jiàn)除壓縮椎體以外的胸腰椎骨密度減低,骨小梁稀疏,骨皮質(zhì)變薄,出現(xiàn)柵狀排列的縱行骨小梁,壓縮的椎體呈楔形、雙凹形或扁平形的骨疏骨折表現(xiàn)。結(jié)論:(1)應(yīng)用DEXA測(cè)定的骨密度值因受檢測(cè)部位、診斷標(biāo)準(zhǔn)不統(tǒng)一、國(guó)家、種族、技術(shù)人員檢測(cè)水平不同以及自身不足等方面的影響,不一定能對(duì)所有脊柱骨疏骨折患者做出精確診斷,在臨床應(yīng)用中存在著一定的局限性。(2)骨代謝指標(biāo)可以評(píng)估脊柱骨疏骨折患者的骨轉(zhuǎn)換情況,在脊柱骨疏骨折的輔助診斷中有著一定的應(yīng)用價(jià)值。(3)對(duì)于老年脊柱骨折患者,骨密度聯(lián)合骨代謝生化指標(biāo)、受傷經(jīng)過(guò)、影像學(xué)表現(xiàn)可以更加準(zhǔn)確的判斷骨折是否是骨質(zhì)疏松所引起的病理性骨折。
[Abstract]:Objective: To investigate the spinal osteoporotic fracture bone density and biochemical markers of bone metabolism, to explore the application value of bone mineral density and bone metabolism in osteoporotic vertebral fracture, in order to provide diagnostic and therapeutic strategies for improving osteoporotic vertebral fractures. Methods: according to the inclusion criteria and exclusion criteria were collected during January 2015 ~2016 January Department of orthopedics, people's Hospital of Ningxia during the spine, the brittle fracture of spine over the age of 60 elderly patients with a total of 60 cases as the research object, all patients were underwent thoracic X-ray, CT and MRI examination, and detection of lumbar patients (L1-L4) and bilateral hip bone mineral density and bone mineral density on the basis of the measured value of the packet any part of the T score, -2.5 is the non osteoporosis group, any part of the T score is less than -2.5 in osteoporosis group. Osteoporosis group were 34 cases, including 14 cases of male, 20 cases of women, women Who were postmenopausal women, age is 61-85 years old, the average age is 70 years old. The non osteoporosis group were 26 cases, including 9 cases of male, female 17 cases, women were postmenopausal women, age 60-86 years old, the average age was 68.7 years, compared with no statistical significance between the two groups in age. Comparable. Records of alkaline phosphatase of patients in each group (ALP), osteocalcin (BGP), parathyroid hormone (PTH), 25 hydroxyvitamin D (25-OH-VD) and other biochemical markers of bone metabolism and X-ray observation, the expression of CT and MRI imaging. According to Oswestry disability index score (Oswestry dysfunction, Wong-Banker index ODI) facial scale method (FPS-R) to evaluate the clinical symptoms of 60 cases of fragility fractures, and then the comparative analysis between the two groups of biochemical markers of bone metabolism changes and clinical manifestations, and statistical analysis of the relationship between bone density testing site and age, not The difference with the detection rate under the standard of osteoporosis, and to explore the possible causes of brittle fracture of bone density in patients with osteoporosis did not reach values. Results: two groups of patients age, gender comparison between two groups of patients age, gender comparison was not statistically significant (P0.05), the two groups are comparable the comparison results between the two groups; four kinds of bone metabolism index: brittle fracture of spine fracture patients, bone density is divided into parathyroid hormone content, non osteoporosis group in the osteocalcin content, 25- hydroxy vitamin D and alkaline phosphatase and osteoporosis group had no statistical significance; the non osteoporosis group and osteoporosis results: Compared with group ODI index ODI index non osteoporosis group score was 57.90, osteoporosis group ODI index score was 59.67, ODI index score between the two groups was not statistically significant compared with the non osteoporosis group; Osteoporosis group FPS-R score comparison results: non osteoporosis group average FPS-R score (7.5 + 0.5), osteoporosis group average FPS-R score (7.9 + 0.7) points, FPS-R scores between the two groups comparison was not statistically significant; score detected in different parts of the age comparison results of minimum T values: minimum T bone density the average score in the average age of the patients with lumbar at the age of 65, the lowest T bone density score in the average age of patients with hip at the age of 73, the difference was statistically significant; different criteria for the prevalence of osteoporosis results: using 2.0SD as the diagnostic criteria of osteoporosis detection rate was 75%, with 2.5SD diagnosis the prevalence of osteoporosis was 50%, the difference was statistically significant; 60 cases of spinal fractures in brittle features: can see images of thoracolumbar spinal vertebral compression density except outside decreased trabecular thinning, cortical thinning, grating The longitudinal bone trabecular arrangement, vertebral wedge-shaped bone thinning, concave or flat fracture. Conclusion: (1) bone mineral density DEXA was used to determine the value of detection by site, diagnosis standard is not unified, national, racial, effects of technical personnel detection level and different aspects of their own is not enough and not be able to make accurate diagnosis of all spinal osteoporotic fracture patients in the clinical application, there are some limitations. (2) bone metabolism index can evaluate spinal osteoporotic fracture patients with bone transformation, has a certain application value in the diagnosis of spinal osteoporotic fractures (3) for the. Elderly patients with spinal fracture, biochemical index, density of bone metabolism bone injuries through imaging, can more accurately determine whether the fracture is a pathologic fracture caused by osteoporosis.

【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R580;R683

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