脊柱结核与化脓性脊柱炎全身与局部骨结构比较  

Comparison of systemic and local bone structures in spinal tuberculosis and suppurative spondylitis

作　　者：李石磊 张宏其[1] 李韬 袁小港 郭超峰[1] 唐明星[1] 刘少华[1] 李艳冰[2] 易小平[3] 高琪乐[1] LI Shi-lei;ZHANG Hong-qi;LI Tao;YUAN Xiao-gang;GUO Chao-feng;TANG Ming-xing;LIU Shao-hua;LI Yan-bing;YI Xiao-ping;GAO Qi-le(Department of Spinal Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Clinical Lab,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Radiology,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科脊柱外科,湖南长沙410008 [2]中南大学湘雅医院检验科,湖南长沙410008 [3]中南大学湘雅医院放射科,湖南长沙410008

出　　处：《中国矫形外科杂志》2022年第10期920-924,共5页Orthopedic Journal of China

基　　金：湖南省自然科学基金项目(编号:2019JJ80014,907014257027,2019JJ40525,No.2019JJ40523,No.2020JJ4892);国家自然科学基金项目(编号:82072460)。

摘　　要：[目的]比较脊柱结核(spinal tuberculosis, STB)和化脓性脊柱炎(pyogenic spondylitis, PS)患者的全身骨密度(bone mineral density, BMD)与病灶局部骨结构的差异。[方法]收集中南大学湘雅医院脊柱外科的脊柱骨质破坏患者36例,分为STB组与PS组,两组患者按性别进行配对,比较两组全身术前骨密度、病椎与邻椎的CT灰度值、术中取出的病灶周围骨组织体积骨量(bone volume/tissue volume, BV/TV)、骨小梁厚度(thickness of trabecular bone, Tb.Th)和骨小梁分离度(sparse density of trabecular, Tb.Sp)。[结果] STB组与PS组腰椎总和骨密度、股骨颈部骨密度、转子区骨密度、Ward三角区骨密度的差异均无统计学意义(P>0.05),PS患者革兰染色阳性组与阴性组间腰椎总和骨密度、股骨颈部骨密度、转子区骨密度、Ward三角区骨密度比较,差异均无统计学意义(P>0.05)。STB组病椎CT灰度值显著大于PS组(P<0.05)。STB组和PS组病灶周围硬化骨质CT灰度值均显著增高(P<0.05),且是STB组显著高于PS组(P<0.05)。STB组的BV/TV和Tb.Th显著高于PS组(P<0.05),前者的Tb.Sp显著小于后者(P<0.05)。[结论]与PS相比,脊柱结核患者病灶周围病理性成骨更显著,病灶局部骨小梁密度、厚度增高,但两组患者全身骨密度无显著差异。[Objective] To compare the general bone mineral density(BMD) and local bone structure around the lesion between spinal tuberculosis(STB) and pyogenic spondylitis(PS). [Methods] A total of 36 patients who received surgical treatment for spinal bone destruction secondary to infection in the Department of Spine Surgery, Xiangya Hospital, Central South University were enrolled into this study,and divided into spinal tuberculosis(STB) group and pyrogenic spondylitis(PS) group based on the consequence of microbiologic assays.The two groups were paired according to gender, and were compared in terms of the preoperative general BMD, CT grayscales of affected vertebra and adjacent vertebra. In addition, the bone volume/tissue volume(BV/TV), thickness of trabecular bone(Tb.Th) and sparse density of trabecular(Tb.Sp) measured on the trabecular bone around the lesion taken out during the operation by micro-CT were compared between the two group. [Results] There were no significant differences between STB group and PS group in terms of the BMDs of the total lumbar, cervical vertebra, femoral intertrochanteric area and the Ward triangle(P>0.05), neither in BMDs of aforesaid areas between the Gram-positive subgroup and Gram-negative subgroup of the PS patients(P>0.05). The STB group had significantly higher CT grayscales than the PS group(P<0.05). The CT grayscales of sclerosed bone around lesions in both groups significantly increased(P<0.05), which in STB group was significantly higher than the PS group(P<0.05). In term of micro-CT, the STB group got significantly higher BV/TV and TB.Th, whereas significantly lower Tb.Sp than the PS group(P<0.05). [Conclusion] The STB has more vigorous pathological osteogenesis around lesions than the PS, with increase of density and thickness of local bone trabeculae, however, there was no significant difference in general BMD between the two groups.

关 键 词：脊柱结核 化脓性脊柱炎 骨密度 病灶硬化骨 CT 显微CT 

分 类 号：R529.2[医药卫生—内科学]