Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: Bone adaptation after decreased mechanical loading
Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: Bone adaptation after decreased mechanical loading
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DOI：
10.1016/s8756-3282(00)00374-4
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发表时间：
2000-11-01
期刊：
影响因子：
4.1
通讯作者：
Jacobsen, BK
中科院分区：
文献类型：
--
作者：
Jorgensen, L;Crabtree, NJ;Jacobsen, BK
这项为期一年的急性卒中患者前瞻性研究的目的是确定步行和不对称负重对股骨颈上下部骨矿物质丢失的影响。40例患者接受随访。8人仍然无法行走，而32人在7个月内重新学会独立行走（12人在中风后不久，15人在2个月内，5人在7个月内）。在中风后的第一周内和1年后测量股骨近端的骨密度（BMD）;计算股骨颈下部和上部的区域BMD变化。股骨颈的下部主要受髋关节的压应力的影响，上部受行走期间的拉应力的影响。当根据患者何时重新学会行走比较各组患者的平均BMD损失时，在麻痹侧和非麻痹侧的股骨颈下部发现BMD损失的统计学显著趋势（分别为p < 0.01和p = 0.01），而在股骨颈上部，没有观察到显著趋势（p 0.1）。此外，通过使用测力板对38例在7个月评价时能够独立站立的患者进行站立期间的体重分布进行了评估。BMD变化与不对称负重之间的唯一显著相关性见于瘫痪侧股骨颈下部（r = 0.6，p < 0.001）。总之，本研究表明，股骨颈BMD的减少主要发生在颈部的下部和瘫痪侧。骨密度的损失取决于患者何时或是否重新学会走路，也取决于瘫痪腿的体重。因此，测量股骨颈的下部比测量整个股骨颈更好地估计步态和负重的影响。(C)2000年，Elsevier Science Inc. All rights reserved.
The aim of this I-year prospective study of acute stroke patients was to determine the effects of walking and asymmetrical weight bearing on the loss of bone mineral in the upper and lower femoral neck. Forty patients were followed. Eight remained unable to walk, whereas 32 relearned to walk independently within 7 months (12 shortly after the stroke, 15 by 2 months, 5 by 7 months). Bone mineral density (BMD) was measured in the proximal femur within the first week after stroke and 1 year later; regional BMD changes were computed for the lower and upper femoral neck. The lower part of the femoral neck is mainly influenced by compressive stresses of the hip, the upper part by tensile stresses during walking. When comparing mean BMD loss in groups of patients according to when they relearned to walk, a statistically significant trend in BMD loss was found in the lower femoral neck on both the paretic and nonparetic sides (p < 0.01 and p = 0.01, respectively), whereas, for the upper femoral neck, no significant trend was seen (p 0.1). In addition, the body weight distribution during standing was assessed by use of a force-plate in 38 patients who could stand independently at the 7 month evaluation. The only significant correlation between changes in BMD and asymmetrical weight bearing was found in the lower femoral neck on the paretic side (r = 0.6, p < 0.001). In conclusion, this study shows that the reduction in BMD in the femoral neck occurs mainly in the lower part of the neck and on the paretic side. The BMD loss depended on when or if the patients relearned to walk, but also on the amount of body weight born on the paretic leg. Thus, measuring the lower part of the femoral neck gives a better estimate of the impact of gait and weight bearing than measuring the total femoral neck. (C) 2000 by Elsevier Science Inc. All rights reserved.