Predicting the failure load of the distal radius
Predicting the failure load of the distal radius
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DOI：
10.1007/s00198-003-1380-9
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发表时间：
2003-06-01
影响因子：
4
通讯作者：
Bouxsein, ML
中科院分区：
文献类型：
--
作者：
Muller, ME;Webber, CE;Bouxsein, ML
桡骨远端是早期发现有骨折危险患者的重要部位。由于在体内测量骨强度是不可能的，我们评估了哪种前臂骨评估方法最能预测桡骨远端失效载荷，并计算了手腕骨折的风险因子（Phi（腕））。采用五种不同的技术测量38具尸体前臂标本，以评估前臂远端骨密度、骨矿物质含量、几何形状和小梁结构。骨评估技术包括桡骨双能x线吸收仪（DXA）、桡骨远端4%和20%的周边定量计算机断层扫描（pQCT）、指骨DXA、前臂数字x线放射测量（DXR-BMD）和桡骨定量超声。每个切除半径的失效载荷是通过模拟在伸出的手上摔倒来确定的。极性应力应变指数和皮质含量的pQCT测量值解释了破坏载荷方差的最大部分（r(2)=0.82-0.85）。骨矿物质含量测量通常比pQCT或DXA测量的相应体积或面骨矿物质密度值（r(2)=0.22-0.69）更好地预测失效负荷（r(2)=0.53-0.85）。多元回归分析表明，骨几何测量的增加提高了骨密度测量单独预测失效载荷的能力。在不同的技术和不同的变量在一个给定的技术预测故障负荷的能力有很高的可变性。对腕部骨折风险因子（Phi（腕））的估计显示，在这项研究中，女性在从站立高度坠落时可能会骨折远端桡骨（Phi（腕=）1.04），而男性则可能承受冲击而不会骨折腕部（Phi（腕=）0.79）。
The distal radius is an important site for the early detection of patients at risk for fracture. Since measuring bone strength in vivo is not possible, we evaluated which bone assessment method of the forearm would best predict failure load of the distal radius and computed a factor of risk for wrist fracture (Phi(wrist)). Thirty-eight cadaveric forearm specimens were measured by five different techniques to assess bone density, bone mineral content, geometry and trabecular structure at the distal forearm. The bone assessment techniques included dual-energy X-ray absorptiometry (DXA) of the radius, peripheral quantitative computed tomography (pQCT) of the 4% and 20% distal sites of the radius, DXA of the phalanges, digital X-ray radiogrammetry of the forearm (DXR-BMD), and quantitative ultrasound of the radius. The failure load of each excised radius was determined by simulating a fall on an outstretched hand. The pQCT measurements of polar stress-strain index and cortical content explained the greatest portion of variance in failure load (r(2)=0.82-0.85). Bone mineral content measures were generally better predictors of failure load (r(2)=0.53-0.85) than the corresponding volumetric or areal bone mineral density values (r(2)=0.22-0.69) measured by either pQCT or DXA. Multiple regression analysis showed that the addition of a bone geometry measure improved the ability of a bone density measure alone to predict failure load. There was high variability in the ability of different techniques and different variables within a given technique to predict failure load. Estimates of the factor of risk for wrist fracture (Phi(wrist)) revealed that the women in this study would have been likely to fracture their distal radius upon falling from a standing height (Phi(wrist=)1.04), whereas the men would have likely withstood the impact without fracturing their wrist (Phi(wrist=)0.79).