基于椎体CT扫描的骨密度HU值分析退变性腰椎侧弯患者骨质疏松的发生率和分布规律  

Prevalence and distribution of osteoporosis in degenerative lumbar scoliosis based on Hounsfield units measurement from CT examination

作　　者：王辉[1] 邹达[1] 孙卓然[1] 王龙杰 姜帅[1] 李危石[1] Wang Hui;Zou Da;Sun Zhuoran;Wang Longjie;Jiang Shuai;Li Weishi(Department of Orthopedic,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191

出　　处：《中华解剖与临床杂志》2021年第5期511-516,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨椎体退变性腰椎侧弯(DLS)患者骨质疏松的发生率和分布规律,为骨水泥螺钉的选择性使用提供参考。方法回顾性分析2015年1月—2019年9月北京大学第三医院骨科接受手术治疗的95例DLS患者的临床和影像学资料,其中男20例、女75例,年龄(63.3±6.5)岁。于脊柱X线全长片上测量患者Cobb角、冠状平衡距离(CBD)值,统计患者冠状位失衡分型例数。选择患者主弯和代偿弯内椎体前缘皮质后方2 mm、椎体中部和椎骨后缘皮质前方2 mm三个层面的CT冠状面重建图像,于椎体松质骨部分选择最大可能的椭圆形区域作为骨密度Hounsfield units(HU)值测量兴趣区,取三个层面测量的平均值作为相应椎体的骨密度HU值,同样方法分别测量椎体凸、凹侧的HU值;以L1≤110 HU作为骨质疏松的诊断标准,观察患者骨质疏松发生率,并按观察结果将患者分为正常骨密度组和骨质疏松组两组,进而对比两组患者临床基线资料。观察全组患者主弯与代偿弯内椎体HU值,以及主弯和代偿弯内各椎体及其凸凹两侧骨质疏松的发生情况。结果全组95例患者Cobb角为25.5°±11.1°,CBD为(22.8±18.7)mm,冠状位失衡为A型者74例、B型12例、C型9例。骨密度正常58例(61.1%),骨质疏松37例(38.9%);女性骨质疏松的发生率45.3%(34/75),高于男性的15.0%(3/20),差异有统计学意义(χ2=6.110,P<0.05)。正常骨密度组和骨质疏松组患者的年龄、体质量指数、Cobb角、CBD、侧弯方向、冠状位失衡分型比较,差异均无统计学意义(P值均>0.05)。主弯与代偿弯内椎体HU值:L1为(122.2±45.0)HU、稳定椎为(124.7±44.8)HU、中立椎为(120.9±42.9)HU、上端椎为(124.3±46.1)HU、顶椎(134.4±49.4)HU、下端椎(153.3±63.8)HU、L5椎(169.8±75.8)HU。主弯内各椎体的骨质疏松发生率分别与L1椎体比较,差异均无统计学意义(P值均>0.05);而代偿弯内L5椎体的骨质疏松发生率则低于主弯的L1椎体,分别为17.9%(Objective To demonstrate the prevalence and distribution of osteoporosis in degenerative lumbar scoliosis(DLS)patients based on Hounsfield units(HU)measurement and to provide a reference for the selective use of cement-augmented pedicle screws.Methods Ninety-five DLS patients surgically treated in Peking University Third Hospital from January 2015 to September 2019 were retrospectively reviewed.Patients comprised 20 males and 75 females with a mean age of(63.3±6.5)years old.Cobb's angle and coronal balance distance(CBD)were measured by using the full-spine X-ray.Regions of interest were measured on coronal images of the vertebrae at three separate locations,namely,immediately posterior to the anterior vertebrae margin,in the middle of the vertebral body,and anterior to the posterior vertebrae margin.For each measurement,the largest possible elliptical region of interest was drawn.The cortical margins were excluded to prevent volume averaging.The average of the HU values from the three coronal slices was obtained to provide a mean HU value for each vertebral body.Then,HU measurements for the concavity and convexity of the vertebrae were obtained separately.For HU-based criterion,a cut-off of≤110 HU was used for osteoporosis diagnosis.Patients were divided into two groups according to their diagnosis.General data and HU value of scoliosis related vertebrae were compared between the two groups.Results The mean Cobb angle was 25.5°±11.1°degrees,and the mean CBD was(22.8±18.7)mm.Coronal imbalance type A was detected in 74 patients,type B was detected in 12 patients,and type C was detected in 9 patients.Fifty-eight patients(61.1%)presented with normal bone density,whereas 37 patients(38.9%)presented with osteoporosis.Female patients(34/75,45.3%)were more likely to present with osteoporosis than males(3/20,15.0%)(χ2=6.110,P<0.05).No significant difference was found in age,body mass index,Cobb's angle,CBD,apex orientation of the major curve,and coronal imbalance types between patients with normal bone density and

关 键 词：骨质疏松 退变性腰椎侧弯 HU值 骨水泥螺钉 

分 类 号：R580[医药卫生—内分泌] R682.13[医药卫生—内科学]