CT定量对腰椎术后邻近椎体骨密度变化的评估  

Application of CT quantification in evaluating bone mineral density of adjacent vertebral bodies following lumbar short segment internal fixation

作　　者：张红[1] 刘传梅 张琳[1] 樊子健 庄顺达 江万里 ZHANG Hong;LIU Chuanmei;ZHANG Lin;FAN Zijian;ZHUANG Shunda;JIANG Wanli(Department of Radiology,Affiliated Hospital of Shandong University of TCM,Jinan 250014,China)

机构地区：[1]山东中医药大学附属医院放射科,山东济南250014 [2]山东中医药大学第一临床医学院,山东济南250014

出　　处：《中国中西医结合影像学杂志》2023年第6期672-675,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

摘　　要：目的:利用CT定量评估腰椎短节段内固定术后邻近椎体骨密度变化趋势。方法:回顾性分析因椎管狭窄或椎体滑脱而行腰椎后路短节段(L4~S1)手术的患者86例,术前均行CT检查;于术后5~10 d、3、6、12、18个月5个时间点进行随访,分别随访65、56、63、59和59例,各期均随访到患者34例。统计邻近椎体L1~3术前及术后各个时间点的CT值,使用广义估计方程分析判断CT值变化趋势。结果:与术前相比,L1~3椎体的CT值在术后5~10 d变化不明显,差异无统计学意义(P>0.05);术后3~12个月呈下降趋势,术后12个月降至最低水平,术后18个月缓慢上升,术后3、6、12及18个月与术前相比差异均有统计学意义(均P<0.05)。L1~3椎体在术前及术后各期CT值随时间变化趋势基本一致,均呈先降低后升高趋势,但均未达术前水平。结论:L4~S1椎体内固定术后邻近椎体L1~3 CT值存在先缓慢降低再升高的过程;椎体CT值越低,患者腰椎术后骨质疏松相关并发症风险越高。应积极采取抗骨质疏松症方案,尤其在术后12个月内积极采取预防措施,以减少骨密度降低引起继发病症的可能性。Objective:To evaluate the bone mineral density(BMD)of adjacent vertebral bodies following lumbar short segment internal fixation using CT.Methods:Eighty-six patients who underwent lumbar short segment internal fixation(L4~S1)due to spinal stenosis or spondylolisthesis were analyzed.All patients underwent preoperative CT examination,and follow-up was performed at 5 timepoints,5~10 d after surgery(65 cases),3 months after surgery(56 cases),6 months after surgery(63 cases),12 months after surgery(59 cases)and 18 months after surgery(59 cases).34 patients were all followed up.The preoperative and postoperative CT values of the L1~3 vertebral bodies were analyzed,and the changes of CT values were evaluated by GEE.Results:Compared with preoperative CT value,the CT values of L1~3 vertebral bodies did not change significantly within 5~10 d after surgery(P>0.05).But the CT values had a downward trend from 3 months to 12 months after surgery,it dropped to the lowest level at 12 months after surgery,and increased slowly at 18 months after surgery.The CT values of L1~3 vertebral bodies at 3,6,12 and 18 months after surgery were statistically significant differences from those before surgery(all P<0.05).The CT values of L1~3 vertebral bodies had basically the same trend over time before and after surgery,showing a trend of decreasing-increasing,but none of them reached the preoperative level.Conclusions:There is a slow decreasing-increasing process of CT values of adjacent L1~3 vertebral bodies after L4~S1 fixation surgery.The lower the CT value of vertebral bodies,the higher the risk of osteoporosis-related complications after lumbar surgery.Therefore,the anti-osteoporosis programs should be actively adopted to reduce the possibility of secondary diseases caused by BMD decrease,especially within 12 months after surgery.

关 键 词：腰椎融合术后 骨质疏松 广义估计方程 体层摄影术 X线计算机 

分 类 号：R687.3[医药卫生—骨科学]