弥漫性特发性骨肥厚症CT分型及其与脊柱矢状位形态的相关性研究  

The diffuse idiopathic skeletal hyperostosis classification based on CT and the correlation of ossification and sagittal spinal morphology

作　　者：孙庆宇 王连雷 赵钇伟 高兴帅 陈幸 赵赓 孙峰 刘新宇[1] Sun Qingyu;Wang Lianlei;Zhao Yiwei;Gao Xingshuai;Chen Xing;Zhao Geng;Sun Feng;Liu Xinyu(Department of Spinal Surgery,Qilu Hospital,Shandong University,Ji'nan 250012,China;Department of Orthopaedics,Zhongshan Jishuitan Orthopedics Hospital,Zhongshan 528455,China;Department of Orthopaedics,Zhangqiu District First People's Hospital,Ji'nan 250201,China)

机构地区：[1]山东大学齐鲁医院脊柱外科,济南250012 [2]中山积水潭骨科医院骨科,中山528455 [3]章丘区第一人民医院骨科,济南250201

出　　处：《中华骨科杂志》2021年第21期1519-1527,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81874022,82172483,82102522)。

摘　　要：目的建立弥漫性特发性骨肥厚症(diffuse idiopathic skeletal hyperostosis,DISH)骨化CT分型系统,并分析脊柱前外侧骨化部位及程度与脊柱矢状位形态的相关性。方法回顾性分析2018年10月至2020年10月接受全脊柱CT扫描检查109例60岁以上患者的病历资料,男70例,女39例;年龄(68.4±6.9)岁(范围60~88岁)。采用高分辨率CT密度容积重建图像分析各椎间隙水平脊柱前外侧骨化程度,并建立CT分型系统。矢状位测量参数包括胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、颈椎前凸角(cervical lordosis,CL)、骶骨倾斜角(sacral slope,SS)、胸腰段后凸角(thoracolumbar junction angle,TLJ)。采用改良Abelin-Genevois(AG)矢状面分型将不同脊柱矢状面形态分为:AG1型,脊柱后凸顶点位于中、下胸段(T4~T11);AG2型,胸椎无明显后凸;AG3型,后凸顶点位于胸腰段(T12~L2);AG4型,后凸顶点位于上胸段(T1~T3)。采用组内相关系数(intraclass correlation coefficient,ICC)计算观察者内及观察者间信度。统计分析矢状位参数、AG分型与DISH骨化位置、严重程度的相关性。结果建立的DISH骨化CT分型系统根据脊柱各节段前外侧骨化的严重程度,将DISH骨化分为0~3级。分型系统观察者内ICC值为0.871,观察者间ICC值为0.874。结合Resnick的DISH诊断标准,97例(89.0%)患者存在连续4个骨化等级1级以上的脊柱节段。AG1型患者T4~T11节段骨化等级为(1.24±0.69)级,大于AG2型(0.84±0.71)级和AG3型(1.00±0.70)级,差异有统计学意义(F=23.101,P<0.001);AG3型患者T12~L2节段骨化等级为(1.44±0.87)级,大于AG1型(1.06±0.84)级和AG2型(0.72±0.63)级,差异有统计学意义(F=14.008,P<0.001);未发现AG4型患者。AG1~3型患者在T1~T3节段骨化等级的差异无统计学意义(F=0.303,P=0.738);在整个胸椎和腰椎(T1~L5)总骨化等级的差异有统计学意义(F=14.374,P<0.001),AG1型和AG3型的差异无统计学意义(P=0.254),但均高于AG2型(P<0.001)。Objective To investigate CT classification of diffuse idiopathic skeletal hyperostosis(DISH),and to analyze the correlation between the position of ossification in the anterolateral spine and the sagittal configuration of the spine.Methods The medical records of 109 patients(70 male and 39 female)who underwent whole spine computerized tomography(CT)from October 2018 to October 2020 were retrospectively analyzed.The average age was 68.4±6.9 years old,ranging from 60 to 88 years old.High resolution CT volume rendering technique images were used to assess the degree of anterolateral spinal ossification in each vertebral space,and a CT grading system was established.Sagittal parameters such as thoracic kyphosis(TK),lumbar lordosis(LL),cervical lordosis(CL),sacral slope(SS),and thoracolumbar junction angle(TLJ)of the patients were measured.The sagittal morphology of the spine was divided into four types using the modified Abelin-Genevois(AG)sagittal classification.In AG type 1 patients,the kyphotic vertex was located in the middle of the thoracic spine(T4-T11).In AG type 2 patients,there was no significant kyphotic vertex.In AG type 3 patients,the kyphotic vertex was located in the thoracolumbar segment(T12-L2).In AG type 4 patients,the kyphotic vertex was located in the upper thoracic segment(T1-T3).Inter-observer and intra-observer reliability were calculated by intra-group correlation coefficient(ICC).Statistical analysis was conducted to investigate the correlation between different AG types and ossification location and severity.Results The new DISH grading system classifies the severity of anterolateral spinal ossification in each intervertebral space into grades 0 to 3 with an intra-observer ICC value of 0.871 and inter-observer ICC value of 0.874.Combined with Resnick's DISH diagnostic criteria,97 patients(89.0%)in this study had four consecutive intervertebral spaces with ossification grade 1 or above.For these patients,in T4-T11,the standardized ossification grade of AG type 1 was 1.24±0.69,greater than th

关 键 词：骨肥厚 弥漫性特发性骨骼 脊柱 体层摄影术 螺旋计算机 

分 类 号：R681[医药卫生—骨科学] R816.8[医药卫生—外科学]