全脊柱MRI评估骨质疏松患者椎体骨折的分布特点及临床意义  

Assessing distribution characteristics and clinical significance of vertebral fractures in patients with osteoporosis based on whole spine MRI

作　　者：周佳俊 马飞 冷叶波 徐世财 何宝强 李洋 廖烨晖 唐强 唐超 王清 钟德君 Zhou Jiajun;Ma Fei;Leng Yebo;Xu Shicai;He Baoqiang;Li Yang;Liao Yehui;Tang Qiang;Tang Chao;Wang Qing;Zhong Dejun(Department of Orthopedics,Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China;Department of Orthopedics,Xinqiao Hospital of Army Medical University,Chongqing 400030,China)

机构地区：[1]西南医科大学附属医院骨科,四川省泸州市646000 [2]陆军军医大学新桥医院骨科,重庆市400030

出　　处：《中国组织工程研究》2025年第9期1883-1889,共7页Chinese Journal of Tissue Engineering Research

基　　金：四川省医学会资助项目(S17075,Q22008,Q21005),项目负责人:钟德君;泸州市人民政府与西南医科大学科技战略合作项目(2020LZXNYDJ22),项目负责人:钟德君;西南医科大学附属医院博士科研启动基金(22155),项目负责人:钟德君;四川省科技厅自然基金项目(24NSFSC2177),项目负责人:钟德君。

摘　　要：背景:骨质疏松性椎体骨折是骨质疏松患者最常见的并发症。脊柱MRI作为一种新的成像技术,在诊断骨质疏松性椎体骨折方面的灵敏度远高于X射线平片。但全脊柱MRI费用高,扫描时间长。因此,对于骨质疏松性椎体骨折患者,是否都需要进行全脊柱MRI扫描以及哪些患者需要行全脊柱MRI,目前临床上尚无统一定论。目的:通过观察骨质疏松性椎体骨折患者的全脊柱MRI影像学资料,分析椎体骨折的分布特点,并探讨其临床意义。方法:回顾性分析2018年8月至2022年9月在西南医科大学附属医院骨科就诊并被诊断为骨质疏松性椎体骨折患者的病历资料和MRI图像,根据纳入和排除标准将903例患者纳入研究。收集患者一般资料(年龄、性别、体质量指数)、病史特点(病程时间、脊柱外伤手术史、叩击痛区域、疼痛评分等);通过全脊柱MRI图像分析其椎体骨折特点。首先根据患者椎体骨折数量将患者分为单椎体骨折组(n=484)和多椎体骨折组(n=419),并分析两组间的差异。然后再根据骨折椎体间的最远间隔数是否≥5将多椎体骨折组再分为2个亚组,其中A组(骨折椎体最远间隔数<5)306例,B组(骨折椎体最远间隔数≥5)113例,分析2个亚组间的差异。结果与结论:①903例患者中,骨折椎体≥2个的患者有419例(46.4%);发生胸腰椎区域骨折的患者有654例(72.4%),在胸椎区域加腰椎区域和整个胸椎到腰椎区域同时发生骨折的患者有54例(6%);B组患者中96.5%的患者均存在多区域的叩击痛;②单椎体骨折组和多椎体骨折组相比,两组患者在骨密度、病史时间是否≥1个月、低能量损伤史、查体脊柱轴向叩击痛区域分布及数量比较差异有显著性意义(P<0.05);年龄、性别、体质量指数、是否伴基础疾病、疼痛目测类比评分、是否伴老年胸腰椎骨折史、是否伴胸腰椎手术史与骨折椎体数量无统计学意义(P>0.05);③A组与B�BACKGROUND:Osteoporotic vertebral fractures are the most common complication in patients with osteoporosis.As a new imaging technique,spine magnetic resonance imaging(MRI)is much more sensitive than X-ray film in the diagnosis of osteoporotic vertebral fractures.However,total spine MRI is costly and takes a long time to scan.Therefore,there is no consensus on whether all patients with osteoporotic vertebral fractures need to undergo total spine MRI scan and which patients need to undergo total spine MRI.OBJECTIVE:To analyze the distribution characteristics of vertebral fractures and explore their clinical significance by observing the whole spine MRI data of osteoporotic vertebral fractures patients.METHODS:Data of cases and MRI images of all patients diagnosed with fresh osteoporotic vertebral fractures who visited the Department of Orthopedics,Affiliated Hospital of Southwest Medical University from August 2018 to September 2022 were retrospectively analyzed.903 patients were included in the study based on inclusion and exclusion criteria.General information(age,gender,and body mass index),medical history characteristics(duration of illness,history of trauma surgery,percussion pain area,and pain score)were collected.The characteristics of vertebral fractures were analyzed through whole spine magnetic resonance imaging.Firstly,based on the number of vertebral fractures in patients,they were divided into the single vertebral fracture group(484 cases)and the multi-vertebral fracture group(419 cases),and the differences were analyzed between the two groups.Then,based on whether the farthest interval between the fractured vertebrae was greater than or equal to 5,the multi vertebral fracture group was further divided into two subgroups.Among them,Group A(the farthest interval between the fractured vertebrae was less than 5)contained 306 cases;Group B(with the farthest interval between fractured vertebral bodies greater than 5)included 113 cases.The differences were analyzed between two subgroups.RESULTS AND CONCLUSIO

关 键 词：骨质疏松椎体骨折 全脊柱MRI 骨折特点 骨密度 多椎体骨折 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681