뇌졸중 환자에서 발생한 골다공증의 임상 양상
The Clinical Manifestations of Osteoporosis in the Patients with Cerebral Stroke
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목적: 뇌졸중 환자에서 골다공증의 임상양상을 알아보고, 골밀도와 기능적 지표와의 상관관계를 평가하고자 하였다. 방법: 총 59명의 뇌졸중 환자를 대상으로 하였다. 뇌졸중 발생에서 골밀도 측정까지 기간이 3개월 미만은 1군은 43명, 3개월 이상은 2군은 16명 이었다. 요추와 대퇴부 골절은 방사선 검사를 시행하였고, 요추와 양측 대퇴부에서 골밀도를 측정 후 기능적 지표들과의 상관관계를 평가하였다. 결과: 각각 16명과 3명의 환자에서 요추부 골절과 대퇴부 골절이 발견되었다. 요추와 대퇴부의 골밀도는 두 군 간에 유의한 차이를 보이지 않았다(P> 0.05). 3개월 미만인 1군에서는 상지의 경직 정도와 대퇴부의 골밀도 유의한 양의 상관관계 나타내었고, 3개월 이상인 2군에서는 상지의 경직 정도와 대퇴부의 골밀도는 유의한 양의 상관관계를, 하지의 근력과 요추부의 골밀도와는 의미 있는 음의 상관관계를 나타내었다(P<0.05). 결론: 뇌졸중 환자에서 비교적 높은 요추부 골절율과 골밀도간와 경직의 상관관계가 발견되었다. 따라서, 뇌졸중 초기에 척추와 대퇴골의 골밀도 검사를 통한 적극적인 골다공증의 진단과 치료가 환자의 합병증 감소에 중요할 것이다.
Abstract
Objectives: To investigate clinical manifestations of osteoporosis in the patients with stroke and define relationship between functional parameters and BMD. Methods: The subjects were 43 female and 16 male stroke patients with cerebral infarction (n=40) and cerebral hemorrhage (n=19). Mean age of subjects was 74.19 years. Group 1 patients were 43 cases below three months of the duration from onset to the time to do BMD; group 2 were 16 cases above three months. Clinical parameters were BMD in lumbar spine and both femur of stroke patients, vertebral and femur fracture on radiographs, and relationship between functional parameters and BMD. Results: Of the 59 stroke patients with stroke, 16 (27%) had vertebral fractures and 3 (5%) had femur fracture. There were no significant differences in spine and femur BMD between the two groups (P>0.05). Spasticity of upper extremity was related to BMD of femur in group 1. Motor power of lower extremity and spasticity of upper extremity were related to BMD of group 2 (P<0.05). The neurologic deficit and ADL were unrelated to the BMD of two groups (P＞0.05). Conclusion: Results showed a high prevalence of vertebral fracture in the patients with stroke and there were correlated between BMD and severity of spasticity. Therefore early screening and active management of osteoporosis in the patients with stroke is crucial to prevent possible complications.
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