急性或亚急性骨质疏松性椎体压缩骨折后骨髓水肿MRI信号变化分析  

Analysis of vertebral bone marrow edema in MRI after acute and subacute osteoporotic vertebral compression fracture

作　　者：张芸 王磊[2] 姜强 高观 董建文[2] 薛景才 ZHANG Yun;WANG Lei;JIANG Qiang;GAO Guan;DONG Jianwen;XUE Jingcai(Development of Orthopaedic,Second Affiliated Hospital of Shandong University of TCM,Jinan 250012,China)

机构地区：[1]山东中医药大学中医学院,山东济南250355 [2]山东中医药大学第二附属医院骨科,山东济南250012 [3]山东省威海卫人民医院脊柱外科,山东威海261002 [4]山东省威海卫人民医院重症医学科,山东威海261002

出　　处：《中国中西医结合影像学杂志》2020年第5期508-511,515,共5页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：山东省医药卫生科技发展计划项目(2018WS094)。

摘　　要：目的 :观察急性或亚急性骨质疏松性椎体压缩骨折(OVCFs)发生后椎体的骨髓水肿信号特征。方法 :选择125例OVCFs患者,按骨折时间分为4期:Ⅰ期(0~15 d),Ⅱ期(16~30 d),Ⅲ期(31~60 d),Ⅳ期(61~90 d)。根据T1WI上骨髓水肿在椎体中所占的比例,将其分为3类:轻度(1%~24%)、中度(25%~74%)和重度(75%~100%)。通过MRI矢状位图像的信号特征评价骨髓水肿。结果:所有患者均顺利完成手术,其中Ⅰ期70例,Ⅱ期29例,Ⅲ期12例,Ⅳ期14例。随时间推移,骨髓水肿范围呈逐渐下降趋势,轻度骨髓水肿发生率由8.4%(7/83)升至50.0%(12/24),重度由51.8%(43/83)降至8.3%(2/24),差异均有统计学意义(均P<0.05);信号强度由均匀变为混杂,骨髓水肿的边界逐渐清晰。随着病程延长,楔形畸形由33.7%(28/83)降至8.3%(2/24),椎体形态无变化由12.0%(10/83)降至4.2%(1/24),椎体粉碎畸形由4.8%(4/83)升至33.3%(8/24),差异均有统计学意义(均P<0.05)。结论:骨髓水肿有其特征性表现,其信号变化能大致反映OVCFs患者骨折区愈合情况及继发性病理改变。Objective:To observe the signal characteristics of vertebral bone marrow edema(BME)after acute and subacute osteoporotic vertebral compression fractures(OVCFs).Methods:According to the period since fractures,125 patients were divided into four stages,StageⅠ(0~15 d),StageⅡ(16~30 d),StageⅢ(31~60 d)and StageⅣ(61~90 d).BME was evaluated by the signal changes and intensity patterns on MRI sagittal images.According to the proportion of BME in the vertebral body on T1WI,patients were divided into three categories,mild(1%~24%),moderate(25%~74%)and severe(75%~100%).BME was evaluated by the signal characteristics of MRI sagittal images.Results:There were 70 patients in StageⅠ,29 in StageⅡ,12 in StageⅢand 14 in StageⅣ.Over time,the range of BME showed a gradual decline,with the incidence of mild type increasing from 8.4%to 50.0%,and the incidence of severe type decreasing from 51.8%to 8.3%,with statistically significant differences(both P<0.05).The signal intensity changed from uniform to mixed,and the edge of boundary became clear.The incidence of wedge deformity decreased from 33.7%to 8.3%,the incidence of no change in vertebral body shape decreased from 12.0%to 4.2%,and the incidence of vertebral body crushing deformity increased from 4.8%to 33.3%,which were statistically significant(all P<0.05).Conclusions:BME has its characteristic manifestations,and its signal changes can roughly reflect the healing status of fracture area and secondary pathological changes.

关 键 词：骨质疏松 脊柱 骨折 压缩性 骨髓水肿 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R683[医药卫生—诊断学]