Kuchulukana kwamafuta am'mafupa a msana ndi m'chiuno kunayesedwa ndi DXA
Kulondola kwa DXA pakuyeza magawo osiyanasiyana a thupi la munthu kumasiyana [4-7].Kulondola kwa DXA pakuyeza msana ndi 0.5% ~ 2%, koma nthawi zambiri> 1%.Kulondola kwa chiuno ndi 1% ~ 5%, ndi khosi lachikazi ndi rotor wamkulu (1% ~ 2%) ndipamwamba kuposa makona atatu a Ward (2.5% ~ 5%) (4. 6. 8).Ngakhale kuti pali fupa lalikulu la fupa mu makona atatu a Ward komanso kukhudzika kwake kwakukulu pakusintha kwa BMD [9], kusalondola kwake chifukwa cha malo ake ang'onoang'ono owonetserako ndi zolakwika za zitsanzo ndi kubwerezabwereza zimalepheretsa ntchito yake yachipatala.Pofuna kuchepetsa zotsatira za kusanthula malo olondola pamene mukuchita miyeso ya DXA, chiuno ndi mawondo zinagwedezeka pa chithandizo kuti msana ukhale woona pa nsanja kuti muchepetse lumbar lordosis panthawi ya kutsimikiza kwa BMD mu anteroposteric lumbar position (posteroposteric). PA).Panthawi yojambula m'chiuno, ntchafuyo idagwidwa pang'ono ndikutchulidwa, ndipo mothandizidwa ndi chipangizo cha postural fixation, khosi lachikazi linayikidwa mofanana ndi tebulo lojambula kuti lisawonjezere BMD chifukwa cha kufupikitsa khosi lachikazi (kuchepetsedwa kwa voliyumu mofanana. fupa la mineral content).Pakutsimikiza kwa BMD ya m'chiuno ndi DXA, malo osiyanasiyana a mwendo angayambitse zolakwika zazikulu, kuyambira 0.9% mpaka 4.5% pakhosi lachikazi, 1.0% mpaka 6.7% pamakona atatu a Ward, ndi 0.4% mpaka 3.1% kwa trochanter yaikulu [6].Chifukwa chake, DXA ikayang'ana m'chiuno, kaimidwe koyenera kumachepetsa cholakwikacho, chomwe ndi kiyi yowonetsetsa kuti Angle yabwino.
Ngati zotsatira za chiuno cha BMD zoyezedwa ndi DXA sizikugwirizana ndi mawonetseredwe azachipatala, ziyenera kuchitidwa
Wolembayo ayang'ane ngati malo ojambulira ndi olondola;Kumbali ina, asing'anga akuyenera kuganizira za kuwunika kwa BMD.Kuphatikiza pa kukhudzidwa kwa malo pakulondola kwa kuyeza kwa DXA, zifukwa zina zitha kukhudzanso zotsatira za kuyeza.Kulumikizana kwa msana kunatsimikiziridwa ndi DXA.
BMD ya msana imatanthauzidwa ngati kachulukidwe ka thupi lonse la vertebral, kuphatikizapo vertebral body ndi arch (cortical bone to cancellous bone ratio 50:50), aortic calcification, degenerative osteoarthrosis, osteopanthogenic spinous process, callus, ndi compression fractures. zimathandizira pakuchulukirachulukira kwamafuta am'mafupa.Komabe, kusintha kosasinthika monga hyperosteoplasia kumakhala kofala kwambiri kwa okalamba opitirira zaka 70, ndi kufalikira kwa 60%, zomwe zimalepheretsa kuchitapo kanthu ndi kukhudzidwa kwa DXA msana orthotopic muyeso mwa okalamba.Matenda a osteoporosis ndi okwera komanso owopsa mwa anthu azaka zapakati komanso okalamba
Ndi matenda ofala a ukalamba omwe amawopseza thanzi la anthu azaka zapakati ndi okalamba.Pofuna kuthetsa kukhudzidwa kwa zinthu zomwe zili pamwambazi, chitukuko cha teknoloji ya DXA lumbar lateral scanning (1121, chojambulira choyambirira cha DXA cha scanning ina ya lumbar, matendawa amatha kukhalabe ndi malo a scanning, omwe ndi
Zakhudza kulondola, zomwe zinali 2.8% mpaka 5.9%!
Pa nthawi yomweyo matenda ena
Anthu, makamaka omwe ali ndi matenda oopsa a osteoporosis, amavutika kutembenuka.
M'zaka zaposachedwa, sikani ya DXA imagwiritsa ntchito kusanthula kwapa mkono kwa mawonekedwe a "C", kulola matenda.
BMD ya msana idayesedwa anteroposterically pamalo apamwamba ndipo scanner ya C-arm idazunguliridwa 90 °.
Wodwala akhoza kuyesedwa ndi DXA mu malo ozungulira a mbiri yakale popanda kusuntha
Kulondola kwa kuyeza kwapakati kunali 1.6% mwa anthu wamba ndi 2% mwa odwala osteoporosis.Muyeso woyenera wa DXA uyenera kusanthula BMD ya 4 lumbar vertebrae (L1-L).Komabe, L1 ndi L4 zitha kuphimbidwa ndi nthiti ndipo L4 mwachiwonekere imakutidwa ndi fupa la pelvic.Kwa odwala ena, L3 BMD yokha ndi yomwe ingawunikidwe.ROIS (dera lachidwi) lingakhalenso pakatikati pa fupa la vertebral lolemera mu fupa la fupa (cortical bone / cancellous bone ratio ya 10: 90), zomwe zimapangitsa kuti miyeso ya DXA ikhale yovuta kwambiri ndi kusintha kwa BMD kutsogolo kusiyana ndi kutsogolo. .Lateral DXA imagwiritsidwa ntchito m'mitu yathanzi yokhala ndi mafupa osteoporosis (vertebral compression fractures)
Tsankho pakati pa kuwonongeka kwa mafupa chifukwa cha corticosteroids ndilabwino kuposa la PA-DXA, lomwe limapangitsa kuti athe kusiyanitsa fractures ya vertebral ndi yopanda fractures [15].Ngakhale DXA yapita patsogolo kwambiri pakuyeza BMD ya msana.Komabe, chifukwa cha scoliosis, humpback yoopsa komanso yachilendo ya msana [4,61], ntchito ya DXA scanning ndi yovuta, yomwe imakhudza kulondola kwa kutsimikiza kwa DXA ndikuchepetsa kugwiritsa ntchito chipatala kwa DXA.Maphunziro owonjezera akufunika kuti afananize "volumetric" BMD (mg/cm3) yowerengedwa ndi miyeso yapatsogolo ndi yapambuyo ya DXA ndi njira ya QCT.
Kutsimikiza kwa mkono wakutsogolo BMD ndi kapangidwe ka thupi ndi DXA
DXA ikugwiritsidwa ntchito kwambiri kudziwa BM [17].Miyezo ya BMD inkachitidwa mu radius ya distal (cancellous predominance), pakati ndi pakati, ndi distal yachitatu ya radius (cortical predominance) ndi wodwala atakhala pampando moyandikana ndi nsanja yojambulira ndi mkono wakutsogolo womwe uli papulatifomu ndipo dzanja lokhazikika. pa nsanja ndi kuzungulira kwapambuyo.Densitometry ya fupa lonse imathanso kuchitidwa.Izi zimapereka kufananitsa mwadongosolo kwa BMD ya thupi lonse ndi BMD yakomweko.Kusanthula ndikuwunika ubale womwe ulipo pakati pa BMD yokhazikika ndi BMD yakumaloko, ndikupeza malo ovuta kwambiri a mafupa a densitometry, kuti apereke chisankho chabwino kwambiri kwa asing'anga.Kulondola kwa kuyeza kwa BMD kwa thupi lonse ndi 3% mpaka 8%.[Chithunzi patsamba 19] Kulondola kwa BMD yam'manja ndi 0.8% -13%.Chifukwa kulondola kwa DXA BMD ya thupi lonse ndi yocheperapo kusiyana ndi ziwalo zina, fupa ndilochepa
Loose nthawi zambiri si malo omwe amawakonda kuti adziwe.Zotsatira za kusanthula kwa thupi lonse zidawunikidwa ndi pulogalamu yazidziwitso zamatenda oyenera amunthu (minofu yowonda ndi mafuta), ndipo zotsatira za kutsimikiza kwa thupi zidapezedwa ndi DXA.Kugwirizana pakati pa zotsatira za kutsimikiza kwa thupi ndi njira zina zoyezera kulemera kwa thupi kunali kwabwino.Ndi gawo lofunikira lomwe lingaphunziridwe mopitilira.
Nthawi yotumiza: Aug-10-2022