CT值评估特发性脊柱侧凸严重程度与椎体骨密度不对称丢失的相关性研究  

Hounsfield unit for assessing asymmetrical loss of vertebral bone mineral density and its correlation with curve severity in idiopathic scoliosis

作　　者：程云忠[1] 杨宏浩 海涌[1] 关立[1] 刘玉增[1] 潘爱星 张耀申 张瀚文 CHENG Yunzhong;YANG Honghao;HAI Yong;GUAN Li;LIU Yuzeng;PAN Aixing;ZHANG Yaoshen;ZHANG Hanwen(Department of Orthopaedic Surgery,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中华骨与关节外科杂志》2022年第9期675-682,共8页Chinese Journal of Bone and Joint Surgery

基　　金：北京市博士后工作经费资助项目(2022-ZZ-030)。

摘　　要：目的:研究CT值在评估特发性脊柱侧凸(IS)严重程度与椎体骨密度(BMD)不对称丢失相关性的应用价值。方法:回顾性收集2014年1月至2021年12月手术治疗的120例IS患者的临床资料,测量主弯顶椎上方4(Apex-4)至下方4(Apex+4)椎体CT值(VB-HU)和椎弓根螺钉轨迹CT值(PST-HU),同时测量主弯、上胸弯、胸腰弯的上端椎、顶椎、下端椎及稳定椎的VB-HU、PST-HU、不对称性比值(AR)。结果:主弯Apex-4至Apex+4各椎体的平均CT值之间无显著差异;但与Cobb角呈负相关,VB-HU和PST-HU在主弯和次弯的凹侧明显大于凸侧;VB-HU和PST-HU的AR与主弯Cobb角显著相关,在顶点达到峰值,从顶点到末端椎体逐渐减小;椎体BMD的不对称丢失随着脊柱侧凸严重程度的进展而加剧,表现为VB-HU在主弯的凸侧显著下降,而在凹侧下降不明显。结论:CT值评估结果显示,IS严重程度与椎体BMD的不对称丢失密切相关。对于重度IS患者,应优先牵开凹侧椎弓根螺钉以矫正主弯,并在主弯顶椎的凸侧,放置辅助锚钉和较大尺寸的螺钉,以减少手术后螺钉松动的风险。Objective: To assess the asymmetrical loss of vertebral bone mineral density(BMD) and its correlation with curve severity in patients with idiopathic scoliosis(IS) using Hounsfield unit(HU) values measured from CT scans. Methods: Totally 120 IS patients undergoing surgical treatment in our hospital from January 2014 to December 2021 were retrospectively collected. The HU values of vertebral body(VB-HU) and pedicle screw trajectory(PST-HU) were measured from 4 vertebras above(Apex-4) to 4 below(Apex+4)the apical vertebra(Apex) of the major curve. The VB-HU, PST-HU, and asymmetric ratio(AR) at upper end vertebrae(UEV), Apex,lower end vertebrae(LEV) within concave and convex sides of major and minor curves, and stable vertebrae were also obtained. Results:Significant correlation was detected between Cobb angle and VB-HU at periapical levels of major curve. VB-HU and PST-HU at periapical levels were significantly greater within concavity than convexity of both major and minor curves. The AR of VB-HU and PST-HU were significantly correlated to the major curve Cobb angle, and peaked at Apex and gradually diminished from Apex to end vertebras.The asymmetrical loss of BMD aggravated with the progression of curve severity, presenting as VB-HU significantly decreased within convexity and insignificantly decreased within concavity of the major curve. Conclusions: The asymmetrical loss of BMD is associated with the progression of curve severity in IS by CT. For patients with severe IS, distraction of the pedicle screws at concave side should be a priority to correct the major curve, and supplemental anchors as well as larger sized screws should be placed within convex side around Apex of major curve, in order to reduce the risk of screw loosening after surgery.

关 键 词：CT值 骨密度 亨氏单位 特发性脊柱侧凸 低骨量 

分 类 号：R445.3[医药卫生—影像医学与核医学] R682[医药卫生—诊断学]