Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications
Impact of bone density on distal radius fracture patterns and comparison between five different fracture classifications
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DOI：
10.1097/00005131-200304000-00005
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发表时间：
2003-04-01
影响因子：
2.3
通讯作者：
Schneider, E
中科院分区：
文献类型：
--
作者：
Lill, CA;Goldhahn, J;Schneider, E
目的：探讨骨密度(BMD)和骨几何形状对桡骨远端破坏载荷和骨折类型的影响，并比较5种不同的骨折分类。设计：生物力学和放射学体外研究。地点：研究室。主要结果测量：对118例来自老年捐献者的完整前臂标本进行常规X线片和外周定量计算机断层扫描(PQCT)检查，以确定骨密度和骨折几何形状。前臂接受了标准化的生物力学测试，模拟伸展的手摔倒。按AO(33例)、Cooney(9例)、Fernandez(15例)、Frykman(17例)和Melone(31例)的X线片对骨折进行分类。结果：骨折性质与骨折类型的相关性(r=0.09~0.70)提示骨折严重程度越重，骨质量越差。破坏载荷与骨性能的相关性最高的是皮质面积(r=0.70)和骨小梁密度(r=0.60)。Cooney分型(9例)、AO分型(33例)与X线分型有较好的相关性(r=0.68)。Fernandez(15)分类(r=0.65)。Frykman(17)(r=0.44)和Melone(31)(r=0.27)分类的值较小。结论：随着骨质疏松程度的增加，失效载荷降低，骨折严重程度增加。该患者群体的骨折类型可以用AO(33)和Cooney(9)分类进行适当的分级。传统的X光检查往往低估了桡骨远端骨折的严重程度，在选择骨折治疗方案时需要考虑到这一点。
Objective: To investigate the impact of bone mineral density (BMD) and bone geometry on failure loads and fracture patterns of the distal radius and to compare 5 different fracture classifications.Design: Biomechanical and radiologic in vitro study.Setting: Research laboratory.Main Outcome Measurements: A total of 118 intact human forearms from elderly donors were examined by means of conventional radiography and peripheral quantitative computed tomography (PQCT) to determine BMD and geometry. The forearms were subjected to a standardized biomechanical test simulating a fall on the outstretched hand. The distal radius fractures were classified from x-rays using the AO (33), Cooney (9), Fernandez (15), Frykman (17), and Melone (31) classifications. The grading was repeated after preparation and direct visual inspection of the fracture site and was correlated with radiographic results, Fracture patterns also were correlated with BMD and geometry.Results: Correlations between bone properties and fracture patterns (r = 0.09-0.70) suggested an increase in the severity of fractures with decreasing bone quality. The highest correlation between failure load and bone properties was found for the cortical area (r = 0.70) and trabecular density (r = 0.60). Good correlations between radiographic and direct visual classification were obtained for the Cooney (9) (r = 0.70), the AO (33) (r = 0.68). and the Fernandez (15) (r = 0.65) classifications. Smaller values were found for the Frykman (17) (r = 0.44) and the Melone (31) (r = 0.27) classifications.Conclusions: With increasing osteopenia, the load to failure decreases, and the severity of fractures increases. Fracture patterns in this patient Population can be adequately graded with the AO (33) and Cooney (9) classifications. The severity of distal radius fractures tends to be underestimated by conventional x-ray examination, which needs to be taken into account when a fracture treatment plan is selected.