Evaluation of bone strength using finite-element analysis in patients with ossification of the posterior longitudinal ligament
Evaluation of bone strength using finite-element analysis in patients with ossification of the posterior longitudinal ligament
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DOI：
10.1016/j.spinee.2022.02.018
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发表时间：
2022-07-15
期刊：
影响因子：
4.5
通讯作者：
Oshima, Yasushi
中科院分区：
文献类型：
--
作者：
Doi, Toru;Ohashi, Satoru;Oshima, Yasushi
背景背景：后纵韧带骨化（OPLL）患者通常报告骨密度（BMD）升高。据报道，通过基于定量计算机断层扫描的有限元分析（QCT/1-EA）测量的股骨近端骨强度在有和没有OPLL的健康受试者之间具有可比性。然而，有症状的OPLL患者的骨强度仍然未知。目的：探讨QCT/1-EA在有症状的OPLL患者中的骨强度测定。研究设计/设置：单中心前瞻性观察性研究。患者样本：共有157例颈椎或胸椎压缩性脊髓病患者被纳入研究。结果指标：我们分析了患者的特征、日本骨科协会（JOA）评分、血清实验室测试（包括钙（Ca）、无机磷酸盐（Pi）和骨转换标志物）、双能x线骨密度仪测量股骨近端和腰椎的骨密度，并使用QCT/1-EA测量股骨近端和腰椎的骨强度（PBS）。方法：将符合条件的患者分为非OPLL组和OPLL组。通过分类变量的Fisher精确检验和连续变量的unpaired t检验，我们比较了患者的特征、JOA评分、实验室数据、骨密度、股骨近端和腰椎PBS在非OPLL组、男性和女性患者之间的差异。然后，在计算倾向得分后，我们使用逆概率加权逻辑回归模型来比较两组之间的骨代谢相关标志物、骨密度和PBS测量值。结果：157例符合条件的患者中，非OPLL组68例，OPLL组89例。与非OPLL组相比，OPLL组患者的总年龄明显更年轻，男性和女性的BMI都明显更高。有OPLL组患者的JOA评分和女性患者的JOA评分均显著高于无OPLL组。与非OPLL组相比，在逆概率加权法中，OPLL组女性患者的Ca水平显著降低，总患者或男性患者的Pi水平显著降低。股骨近端、腰椎BMD及股骨近端PBS均明显高于无OPLL组。男性亚组间PBS和BMD无显著差异。然而，患有OPLL的女性股骨近端和腰椎的BMD和PBS明显高于未患OPLL的女性。结论：QCT/FEA显示，OPLL后纵韧带增生与较高的骨强度相关，尤其是女性OPLL患者。(C) 2022爱思唯尔公司版权所有。
BACKGROUND CONTEXT: Patients with ossification of the posterior longitudinal ligament (OPLL) are often reported to have increased bone mineral density (BMD). The bone strength of the proximal femur measured by quantitative computed tomography-based finite element analysis (QCT/1-EA) is reportedly comparable between healthy subjects with and without OPLL. However, the bone strength in symptomatic OPLL patients remains unknown.PURPOSE: To investigate bone strength measured by QCT/1-EA in symptomatic patients with OPLL.STUDY DESIGN/SETTING: A single-center prospective observational study.PATIENT SAMPLE: A total of 157 patients with cervical or thoracic compressive myelopathy were included in the study.OUTCOME MEASURES: We analyzed patients' characteristics, Japanese Orthopedic Association (JOA) score, serum laboratory tests including calcium (Ca), inorganic phosphate (Pi), and bone turnover markers, BMD of the proximal femur and lumbar spine measured using dual-energy X-ray absorptiometry, and predicted bone strength (PBS) of the proximal femur and lumbar spine measured using QCT/1-EA.METHODS: Eligible patients were divided into the non-OPLL and OPLL groups. We compared the patients' characteristics, JOA scores, laboratory data, BMD, and PBS of the proximal femur and lumbar spine between the non-OPLL and OPLL groups among total, male, and female patients by performing Fisher's exact test for categorical variables and the unpaired t test for continuous variables. Then, we used the inverse probability weighted logistic regression model after calculating propensity scores to compare the bone metabolism-associated markers, BMD, and PBS measurements between the groups.RESULTS: Among the eligible 157 patients, 68 were in the non-OPLL group and 89 were in the OPLL group. Compared with the non-OPLL group, the OPLL group had a significantly younger age and higher BMI in the total, male, and female patients. The JOA scores in the total and female patients were significantly higher in the OPLL group than in the non-OPLL group. The OPLL group showed significantly lower Ca levels in the female patients and significantly lower Pi levels in the total or male patients compared with the non-OPLL group in the inverse probability weighting method. The BMD of the proximal femur and lumbar spine and the PBS of the proximal femur were significantly higher in the OPLL group than in the non-OPLL group. There were no significant differences in the PBS and BMD between the male subgroups. However, the BMD and PBS of the proximal femur and lumbar spine were significantly higher in the OPLL females than in the non-OPLL females.CONCLUSIONS: Hyperostosis of the posterior longitudinal ligament in OPLL was associated with higher bone strength by QCT/FEA, especially in female OPLL patients. (C) 2022 Elsevier Inc. All rights reserved.