椎体脂肪化对椎体骨质疏松性骨折风险的评价意义  

Evaluation of the Significance of Vertebral Body Steatosis on the Risk of Vertebral Osteoporotic Fracture

作　　者：徐荣健 郑杰文 何磊 钱宇[1,4] Xu Rongjian;Zheng Jiewen;He Lei;Qian Yu(Wenzhou Medical University,Wenzhou 325031,China;Department of Orthopaedics,Shaoxing People’s Hospital,Shaoxing 312035,China;Shaoxing University,Shaoxing 312000,China;Department of Orthopaedics,Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310060,China)

机构地区：[1]温州医科大学,浙江温州325031 [2]绍兴市人民医院骨科,浙江绍兴312035 [3]绍兴文理学院,浙江绍兴312000 [4]浙江省中医院骨科,浙江杭州310060

出　　处：《实用骨科杂志》2023年第5期395-399,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨椎体脂肪化在椎体骨质疏松性骨折(vertebral osteoporotic fracture,VOF)中的意义。方法收集2016年4月至2021年6月绍兴市人民医院行椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗的VOF患者和同时期的体检患者,根据年龄性别进行配对,共配对出168例分别作为骨折组和非骨折组,其中男58例,女110例;年龄50~89岁,平均(64.78±7.32)岁。对其MRI影像数据进行椎体脂肪化面积比(vertebral fat area ratio,VFAR)、椎体脂肪信号强度比值(vertebral fat signal ratio,VFSR)和椎体脂肪化指数(vertebral fat index,VFI)的定量测量。单项因素比较两组间差异,分析椎体脂肪化与VOF的相关性;将骨折组和非骨折组进一步按照性别、年龄进行亚组分组并行配对样本t检验统计分析;并分析VFAR、VFSR和VFI对VOF的诊断效能。结果骨折组的VFAR、VFSR和VFI均显著高于非骨折组,差异有统计学意义(P<0.05)。VFAR判断VOF的受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.6430,诊断骨折的临界值为0.1576;VFSR判断VOF的ROC曲线下面积为0.5808,诊断骨折的临界值为0.7415;VFI判断VOF的ROC曲线下面积为0.6455,诊断骨折的临界值为0.1022。结论椎体脂肪化是患者发生VOF的重要危险因素,椎体脂肪化对于VOF诊断具有一定的价值。Objective To investigate the role of MRI vertebral fat fraction in the prediction of vertebral osteoporotic fracture(VOF).Methods The study aimed to collect patient data from April 2016 to June 2021 who underwent percutaneous kyphoplasty(PKP)treatment for pathologic bone fracture caused by osteoporosis,as well as examine patients during the same period.A total of 168 patients were matched based on gender and age and divided into fracture and non-fracture groups.58 male and 110 female patients were included,with ages ranging from 50 to 89 years,average age of(64.78±7.32)years.Quantitative measurements were conducted on MRI images to determine the vertebral fat area ratio(VFAR),vertebral fat signal ratio(VFSR),and vertebral fat index(VFI).Single-factor comparisons were made between the two groups to analyze the correlation between vertebral body steatosis and vertebral osteoporotic fracture(VOF).Further subgroup analyses were conducted based on gender and age,followed by paired-sample t-tests between the fracture and non-fracture groups.The diagnostic efficiency of VFAR,VFSR,and VFI for VOF was also assessed using the ROC curve.Results The fracture group's VFAR,VFSR,and VFI were significantly higher than the non-fracture group's(P<0.05).The VOF area under the ROC curve as determined by VFAR is 0.6430,and the critical value for fracture diagnosis was 0.1576.The area under the ROC curve for VOF as determined by VFSR was 0.5808,and the critical value for fracture diagnosis was 0.7415.The area under the ROC curve for VOF as determined by VFI was 0.6455,and the critical value for fracture diagnosis was 0.1022.Conclusion Adiposity of the vertebral body is an important risk factor for the development of VOF in patients,and it has some value in VOF diagnosis.

关 键 词：腰椎 骨质疏松 椎体脂肪化 骨质疏松性骨折 

分 类 号：R683.2[医药卫生—骨科学]