脊髓损伤患者股骨远端和胫骨近端骨密度的变化

doi:10.3969/j.issn.1006-9771.2022.07.018

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (7): 855-858.doi: 10.3969/j.issn.1006-9771.2022.07.018

脊髓损伤患者股骨远端和胫骨近端骨密度的变化

康海琼^1,²,周红俊^1,²(),刘根林^1,²,卫波^1,²,郑樱^1,²,张缨^1,²,郝春霞^1,²,王一吉^1,²,逯晓蕾^1,²,袁媛^1,²,蒙倩茹^1,²

1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院,北京市 100068

收稿日期:2022-05-06 修回日期:2022-06-09 出版日期:2022-07-25 发布日期:2022-08-08
通讯作者: 周红俊 E-mail:zh87569303@qq.com
作者简介:康海琼(1979-),女,汉族,山东诸城市人,硕士,主治医师,主要研究方向：脊髓损伤康复。
基金资助:
中国康复研究中心课题(2018ZX-Q8)

Changes of bone mineral density in distal femur and proximal tibia in patients with spinal cord injury

KANG Haiqiong^1,²,ZHOU Hongjun^1,²(),LIU Genlin^1,²,WEI Bo^1,²,ZHENG Ying^1,²,ZHANG Ying^1,²,HAO Chunxia^1,²,WANG Yiji^1,²,LU Xiaolei^1,²,YUAN Yuan^1,²,MENG Qianru^1,²

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2022-05-06 Revised:2022-06-09 Published:2022-07-25 Online:2022-08-08
Contact: ZHOU Hongjun E-mail:zh87569303@qq.com
Supported by:
China Rehabilitation Research Center Project(2018ZX-Q8)

摘要/Abstract

摘要：

目的探讨脊髓损伤患者发病早期股骨远端及胫骨近端骨密度变化的规律。

方法选择2018年11月至2021年1月在北京博爱医院住院行康复治疗的脊髓损伤患者9例,测量入院时及入院6个月后股骨远端、胫骨近端、全髋和股骨颈骨密度。

结果与入院时相比,患者股骨远端、胫骨近端、全髋和股骨颈骨密度在入院6个月后均明显下降(∣Z∣ > 2.265, P < 0.01)。股骨颈的骨密度下降百分数与第2次测量时下肢运动评分呈负相关(r = -0.515, P = 0.035)。

结论脊髓损伤患者发病一年内股骨远端及胫骨近端骨密度明显下降。

关键词: 脊髓损伤, 骨密度, 股骨远端, 胫骨近端

Abstract:

Objective To investigate the changes of bone mineral density of distal femur and proximal tibia in patients with spinal cord injury.

Methods Nine inpatients with spinal cord injury in Beijing Bo'ai Hospital for rehabilitation from November, 2018 to January, 2021 were recruited. The bone mineral density of distal femur, proximal tibia, total hip and femoral neck at admission and six months after admission was measured.

Results Compared with the results of admission, the bone mineral density of distal femur, proximal tibia, total hip and femoral neck decreased significantly six months after admission (∣Z∣ > 2.265, P < 0.01). The percentage of decreased bone mineral density in the femoral neck was inversely correlated with the lower extremity movement score at the second measurement (r = -0.515, P = 0.035).

Conclusion Within one year after the onset of spinal cord injury, the bone mineral density of distal femur and proximal tibia decreases.

Key words: spinal cord injury, bone mineral density, distal femur, proximal tibia

中图分类号:

R651.2

康海琼,周红俊,刘根林,卫波,郑樱,张缨,郝春霞,王一吉,逯晓蕾,袁媛,蒙倩茹. 脊髓损伤患者股骨远端和胫骨近端骨密度的变化[J]. 《中国康复理论与实践》, 2022, 28(7): 855-858.

KANG Haiqiong,ZHOU Hongjun,LIU Genlin,WEI Bo,ZHENG Ying,ZHANG Ying,HAO Chunxia,WANG Yiji,LU Xiaolei,YUAN Yuan,MENG Qianru. Changes of bone mineral density in distal femur and proximal tibia in patients with spinal cord injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 855-858.

图/表 2

参考文献 36

[1]	MORSE L R, BATTAGLINO R A, STOLZMANN K L, et al. Osteoporotic fractures and hospitalization risk in chronic spinal cord injury[J]. Osteoporos Int, 2009, 20(3): 385-392. doi: 10.1007/s00198-008-0671-6
[2]	FREEHAFER A A. Limb fractures in patients with spinal cord injury[J]. Arch Phys Med Rehabil, 1995, 76(9): 823-827. doi: 10.1016/S0003-9993(95)80546-X
[3]	HARTKOPP A, MURPHY R J, MOHR T, et al. Bone fracture during electrical stimulation of the quadriceps in a spinal cord injured subject[J]. Arch Phys Med Rehabil, 1998, 79(9): 1133-1136. doi: 10.1016/S0003-9993(98)90184-8
[4]	FILIPPO T R, DE CARVALHO M C, CARVALHO L B, et al. Proximal tibia fracture in a patient with incomplete spinal cord injury associated with robotic treadmill training[J]. Spinal Cord, 2015, 53(12): 875-876. doi: 10.1038/sc.2015.27
[5]	COUPAUD S, MCLEAN A N, LLOYD S, et al. Predicting patient-specific rates of bone loss at fracture-prone sites after spinal cord injury[J]. Disabil Rehabil, 2012, 34(26): 2242-2250. doi: 10.3109/09638288.2012.681831
[6]	DAUTY M, PERROUIN VERBE B, MAUGARS Y, et al. Supralesional and sublesional bone mineral density in spinal cord-injured patients[J]. Bone, 2000, 27(2): 305-309. doi: 10.1016/S8756-3282(00)00326-4
[7]	ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI): what's new?[J]. Spinal Cord, 2019, 57(10): 815-817. doi: 10.1038/s41393-019-0350-9
[8]	KANIS J A. Diagnosis of osteoporosis and assessment of fracture risk[J]. Lancet, 2002, 359(9321): 1929-1936. doi: 10.1016/S0140-6736(02)08761-5
[9]	MCPHERSON J G, EDWARDS W B, PRASAD A, et al. Dual energy X-ray absorptiometry of the knee in spinal cord injury: methodology and correlation with quantitative computed tomography[J]. Spinal Cord, 2014, 52(11): 821-825. doi: 10.1038/sc.2014.122
[10]	CIRNIGLIARO C M, MYSLINSKI M J, LA FOUNTAINE M F, et al. Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options[J]. Osteoporos Int, 2017, 28(3): 747-765. doi: 10.1007/s00198-016-3798-x
[11]	LALA D, CRAVEN B C, THABANE L, et al. Exploring the determinants of fracture risk among individuals with spinal cord injury[J]. Osteoporos Int, 2014, 25(1): 177-185. doi: 10.1007/s00198-013-2419-1
[12]	BAUMAN W A, CIRNIGLIARO C M, LA FOUNTAINE M F, et al. Zoledronic acid administration failed to prevent bone loss at the knee in persons with acute spinal cord injury: an observational cohort study[J]. J Bone Miner Metab, 2015, 33(4): 410-421. doi: 10.1007/s00774-014-0602-x
[13]	MORSE L R, BIERING-SOERENSEN F, CARBONE L D, et al. Bone mineral density testing in spinal cord injury: 2019 ISCD official position[J]. J Clin Densitom, 2019, 22(4): 554-566. doi: 10.1016/j.jocd.2019.07.012
[14]	ZEHNDER Y, LÜTHI M, MICHEL D, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men[J]. Osteoporos Int, 2004, 15(3): 180-189. doi: 10.1007/s00198-003-1529-6
[15]	ABDERHALDEN L, WEAVER F M, BETHEL M, et al. Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders[J]. Osteoporos Int, 2017, 28(3): 925-934. doi: 10.1007/s00198-016-3841-y
[16]	CHOI H, CHANG S Y, YOO J, et al. Correlation between duration from injury and bone mineral density in individuals with spinal cord injury[J]. Ann Rehabil Med, 2021, 45(1): 1-6. doi: 10.5535/arm.20169
[17]	CLARK J M, JELBART M, RISCHBIETH H, et al. Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss[J]. Spinal Cord, 2007, 45(1): 78-85. doi: 10.1038/sj.sc.3101929
[18]	BAUMAN W A, CARDOZO C P. Osteoporosis in individuals with spinal cord injury[J]. PM R, 2015, 7(2): 188-201. doi: 10.1016/j.pmrj.2014.08.948
[19]	ESER P, FROTZLER A, ZEHNDER Y, et al. Relationship between the duration of paralysis and bone structure: a pQCT study of spinal cord injured individuals[J]. Bone, 2004, 34(5): 869-880. doi: 10.1016/j.bone.2004.01.001
[20]	JIANG S D, JIANG L S, DAI L Y. Mechanisms of osteoporosis in spinal cord injury[J]. Clin Endocrinol (Oxf), 2006, 65(5): 555-565. doi: 10.1111/j.1365-2265.2006.02683.x
[21]	FLUECK J L, PERRET C. Vitamin D deficiency in individuals with a spinal cord injury: a literature review[J]. Spinal Cord, 2017, 55(5): 428-434. doi: 10.1038/sc.2016.155
[22]	康海琼, 周红俊, 卫波, 等. 135例脊髓损伤患者骨代谢标志物的回顾性分析[J]. 中国康复理论与实践, 2021, 27(2): 156-163.
	KANG H Q, ZHOU H J, WEI B, et al. Bone metabolism biochemical markers for spinal cord injury: a retrospective study of 135 patients[J]. Chin J Rehabil Theory Prac, 2021, 27(2): 156-163.
[23]	LE B, RAY C, GONZALEZ B, et al. Laboratory evaluation of secondary causes of bone loss in veterans with spinal cord injury and disorders[J]. Osteoporos Int, 2019, 30(11): 2241-2248. doi: 10.1007/s00198-019-05089-1
[24]	DUDLEY-JAVOROSKI S, SAHA P K, LIANG G, et al. High dose compressive loads attenuate bone mineral loss in humans with spinal cord injury[J]. Osteoporos Int, 2012, 23(9): 2335-2346. doi: 10.1007/s00198-011-1879-4
[25]	COUPAUD S, MCLEAN A N, PURCELL M, et al. Decreases in bone mineral density at cortical and trabecular sites in the tibia and femur during the first year of spinal cord injury[J]. Bone, 2015, 74: 69-75. doi: 10.1016/j.bone.2015.01.005
[26]	FREY-RINDOVA P, DE BRUIN E D, STÜSSI E, et al. Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography[J]. Spinal Cord, 2000, 38(1): 26-32. doi: 10.1038/sj.sc.3100905
[27]	BEN M, HARVEY L, DENIS S, et al. Does 12 weeks of regular standing prevent loss of ankle mobility and bone mineral density in people with recent spinal cord injuries?[J]. Aust J Physiother, 2005, 51(4): 251-256. doi: 10.1016/S0004-9514(05)70006-4
[28]	KARELIS A D, CARVALHO L P, CASTILLO M J, et al. Effect on body composition and bone mineral density of walking with a robotic exoskeleton in adults with chronic spinal cord injury[J]. J Rehabil Med, 2017, 49(1): 84-87. doi: 10.2340/16501977-2173
[29]	GIANGREGORIO L M, WEBBER C E, PHILLIPS S M, et al. Can body weight supported treadmill training increase bone mass and reverse muscle atrophy in individuals with chronic incomplete spinal cord injury ?[J]. Appl Physiol Nutr Metab, 2006, 31(3): 283-291. doi: 10.1139/h05-036
[30]	BIERING-SØRENSEN F, HANSEN B, LEE B S. Non-pharmacological treatment and prevention of bone loss after spinal cord injury: a systematic review[J]. Spinal Cord, 2009, 47(7): 508-518. doi: 10.1038/sc.2008.177
[31]	GILCHRIST N L, FRAMPTON C M, ACLAND R H, et al. Alendronate prevents bone loss in patients with acute spinal cord injury: a randomized, double-blind, placebo-controlled study[J]. J Clin Endocrinol Metab, 2007, 92(4): 1385-1390. doi: 10.1210/jc.2006-2013
[32]	NANCE P W, SCHRYVERS O, LESLIE W, et al. Intravenous pamidronate attenuates bone density loss after acute spinal cord injury[J]. Arch Phys Med Rehabil, 1999, 80(3): 243-251. doi: 10.1016/S0003-9993(99)90133-8
[33]	WU Y, WANG F, ZHANG Z. The efficacy and safety of bisphosphonate analogs for treatment of osteoporosis after spinal cord injury: a systematic review and meta-analysis of randomized controlled trials[J]. Osteoporos Int, 2021, 32(6): 1117-1127. doi: 10.1007/s00198-020-05807-0
[34]	EDWARDS W B, HAIDER I T, SIMONIAN N, et al. Durability and delayed treatment effects of zoledronic acid on bone loss after spinal cord injury: a randomized, controlled trial[J]. J Bone Miner Res, 2021, 36(11): 2127-2138. doi: 10.1002/jbmr.4416
[35]	MORSE L R, TROY K L, FANG Y, et al. Combination therapy with zoledronic acid and FES-Row training mitigates bone loss in paralyzed legs: results of a randomized comparative clinical trial[J]. JBMR Plus, 2019, 3(5): e10167. doi: 10.1002/jbm4.10167
[36]	CHAMPS A P S, MAIA G A G, OLIVEIRA F G, et al. Osteoporosis-related fractures after spinal cord injury: a retrospective study from Brazil[J]. Spinal Cord, 2020, 58(4): 484-489. doi: 10.1038/s41393-019-0387-9

患者编号	性别	损伤时年龄/岁	第1次检测时病程/d	损伤级别	损伤部位	第1次检测时BMI/kg·m^-2	第1次运动评分				第2次运动评分
							左侧		右侧		左侧		右侧
							股四头肌	下肢	股四头肌	下肢	股四头肌	下肢	股四头肌	下肢
1	女	28	82	B	胸椎	20.1	0	0	0	0	0	0	0	0
2	女	44	109	C	胸椎	24.7	1	2	1	2	3	5	2	4
3	女	30	44	A	胸椎	21.2	0	0	0	0	0	0	0	0
4	男	39	58	A	腰椎	21.6	4	8	4	8	4	8	4	8
5	男	27	117	C	胸椎	21.1	0	0	1	6	0	1	1	10
6	男	41	31	A	颈椎	20.8	0	0	0	0	0	0	0	0
7	男	32	23	A	胸椎	29.4	0	0	0	0	0	0	0	0
8	男	29	201	A	胸椎	22.1	0	0	4	7	0	0	4	8
9	男	41	34	A	腰椎	21.2	4	6	-	-	4	8	-	-

部位	n	第1次/g·cm^-2	第2次/g·cm^-2	骨密度下降百分数/%	Z值	P值
股骨颈	17	0.743(0.610, 0.979)	0.700(0.517, 0.94)	5.02(-10.66, 18.84)	-2.675	0.007
全髋	17	0.872(0.694, 1.094)	0.821(0.558, 0.998)	6.47(-9.65, 25.8)	-2.817	0.005
股骨远端	17	0.847(0.605, 1.034)	0.818(0.458, 0.975)	5.71(-7.51, 30.61)	-2.841	0.004
胫骨近端	17	0.856(0.603, 1.023)	0.819(0.460, 0.932)	9.00(-6.16, 33.10)	-3.479	0.001

脊髓损伤患者股骨远端和胫骨近端骨密度的变化

Changes of bone mineral density in distal femur and proximal tibia in patients with spinal cord injury

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