贯福春
摘要:目的 探討X线、MRI诊断原发性骨质疏松椎体压缩性骨折的临床价值。方法 选取2018年4月~2019年4月在我院诊治的96例椎体压缩性骨折患者为研究对象,根据疾病良恶性分为观察组和对照组,观察组为53例原发性骨质疏松症椎体压缩性骨折,对照组为43例转移瘤继发性椎体压缩性骨折,比较两组X线片、MRI影像图像特点。结果 观察组X线检出椎体骨折72例,以凹陷形为主(65.27%),椎体骨密度降低占93.05%,椎管变形占11.11%,累及终板占30.55%。对照组X线检出椎体骨折23例,形态以楔形压缩为主(56.52%),椎管狭窄占17.39%,累及终板占26.09%。MRI检查出观察组椎体后缘上角或下角后翘占97.22%,T1WI序列显示局限性低信号占38.89%,T2WI脂肪抑制序列显示高信号占58.33%;对照组圆隆状椎体后缘占96.07%,不规则结节状椎体旁软组织肿块占72.54%,骨折病灶T1WI显示弥漫性低信号占86.27%,T2WI脂肪抑制序列显示高信号占92.15%,增强扫描显示明显强化。结论 X线、MRI均可鉴别诊断原发性骨质疏松椎体压缩性骨折和转移瘤继发性椎体压缩性骨折,临床应根据患者具体情况,选择适宜的方案进行检查。
关键词:骨质疏松;椎体压缩性骨折;X线;MRI
中图分类号:R445.2 文献标识码:A DOI:10.3969/j.issn.1006-1959.2020.03.057
文章编号:1006-1959(2020)03-0171-02
The Value of X-ray and MRI in the Diagnosis of Primary Osteoporotic
Compression Fracture of Vertebral Body
GUAN Fu-chun
(Department of Radiology,Dongli Hospital,Dongli District,Tianjin 300300,China)
Abstract:Objective To explore the clinical value of X-ray and MRI in the diagnosis of primary osteoporotic compression fracture of vertebral body. Methods A total of 96 patients with compression fracture of vertebral body diagnosed and treated in our hospital from April 2018 to April 2019 were selected as research subjects. They were divided into observation group and control group according to the benign and malignant disease, and observation group was 53 cases of primary osteoporosis compression fracture of vertebral body in the control group were 43 cases of secondary compression fracture of vertebral body with metastases in the control group. The characteristics of X-ray films and MRI images were compared between the two groups.Results X-ray examination showed that 72 cases of compression fracture of vertebral body in the observation group were mainly depressed (65.27%). The decrease of vertebral bone density accounted for 93.05%, the spinal canal deformation accounted for 11.11%, and the endplate involved 30.55%. In the control group, 23 cases of vertebral fractures were detected by X-ray. The shape was mainly wedge-shaped compression (56.52%), spinal canal stenosis accounted for 17.39%, and endplate involvement involved 26.09%.MRI showed that the upper or lower angle of the posterior margin of the vertebral body in the observation group accounted for 97.22%.T1WI sequence showed localized low signal accounted for 38.89%, T2WI fat inhibition sequence showed high signal accounted for 58.33%; control group rounded vertebral posterior margin accounted for 96.07%, irregular nodular paravertebral soft tissue mass accounted for 72.54%, fracture Lesion T1WI showed diffuse low signal accounting for 86.27, T2WI fat suppression sequence showed high signal accounting for 92.15%, and enhanced scan showed significant enhancement. Conclusion X-ray and MRI can differentiate primary osteoporotic compression fracture of vertebral body and metastatic tumor secondary compression fracture of vertebral body. The appropriate scheme should be selected according to the specific situation of the patient.
Key words:Osteoporosis;Compression fracture of vertebral body;X-ray;MRI
椎体压缩性骨折(compression fracture of vertebral body)是临床常见骨折,常见治疗方式为手术治疗,包括椎体成形术、椎弓根钉固定等。临床手术方式的选择,需要准确了解患者骨折线、骨折程度、椎管狭窄等情况,一般多通过X线、MRI等影像學检查对患者病情进行评估[1]。椎体压缩性骨折有良恶性两种,良性骨折以原发性骨组织疏松骨折为主,恶性以转移性肿瘤骨折为主[2]。正确鉴别诊断椎体压缩性骨折的良恶性,对制定治疗方案、改善患者预后有重要意义。本研究结合2018年4月~2019年4月在我院就诊的96例骨质疏松椎体压缩性骨折患者作为研究对象,评估研究X线、MRI鉴别椎体压缩性骨折良恶性的价值,现报道如下。
1资料与方法
1.1一般资料 选取2018年4月~2019年4月在天津市东丽区东丽医院诊治的96例骨质疏松椎体压缩性骨折患者为研究对象,根据疾病良恶性分为观察组和对照组,观察组为53例原发性骨质疏松症椎体压缩性骨折,对照组为43例转移瘤继发性椎体压缩性骨折。所有患者均经病理检查确诊,排除外伤性椎体压缩性骨折及肝肾功能严重障碍、凝血机制障等患者。观察组中男性31例,女性22例;年龄49~78岁,平均年龄(67.19±2.09)岁。对照组男性28例,女性15例;年龄48~76岁,平均年龄(68.04±1.78)岁。两组年龄、性别比较,差异无统计学意义(P>0.05),具有可比性。所有患者自愿参加本研究,并签署知情同意书。
1.2方法 ①X线检查:首先进行胸腰椎正侧位常规X线片检查,确保中心线与患者L3/4水平对准摄影,腰椎正位、侧位片电压为80~90 KV,电流为35~50 MAs、50~70 MAs。观察患者脊椎病变位置、数目、椎体形态、椎体密度、椎管受累情况以及程度等。②MRI检查:首先进行常规MRI扫描,包括脊柱矢状位(T1WI、T2WI)脂肪抑制、横断位R2WI。T1WI TR、TE分别为500~550 ms、11~20 ms,FSE T2WI TR、TE分别为2500~4000 ms、90~140 ms;颈椎扫描层厚3 mm,层间距1 mm,胸腰椎扫描层厚4 mm,层间距1 mm。随后进行增强扫描,肘部注射对比剂,剂量为0.2 mmol/kg,速率为2.5 ml/s。全面观察病变椎体信号、分布、形态、椎旁软组织是否存在肿块、椎管是否狭窄等情况。
1.3观察指标 观察两组脊椎病变位置、数目、椎体形态、椎体密度、椎管受累情况
1.4统计学方法 采用Excel 2015录入数据,计数资料采用(%)描述。
2结果
2.1 X线检查结果 ①观察组检出椎体骨折72例,其中椎体上缘或下缘凹陷47例(65.27%),双凹23例(31.94%),扁平形12例(16.67%);椎体骨密度降低67例(93.05%),椎管变形8例(11.11%),累及终板22例(30.55%)。②对照组检出椎体骨折23例,椎体楔形压缩13例(56.52%),椎管狭窄4例(17.39%),累及终板6例(26.09%)。
2.2 MRI检查结果
2.2.1观察组 检出椎体骨折72例,椎体后缘上角或下角后翘70例(97.22%),T1WI序列显示局限性低信号28例(38.89%),T2WI脂肪抑制序列显示高信号42例(58.33%);增强扫描显示病灶信号不均匀增高,椎旁软组织、椎旁均匀环形软组织影9例,显示椎管变形78例;椎体终板骨折中断34例。
2.2.2对照组 检出椎体骨折51例,圆隆状椎体后缘50例(96.07%),不规则结节状椎体旁软组织肿块37例(72.54%);骨折病灶T1WI显示弥漫性低信号44例(86.27%),T2WI脂肪抑制序列显示高信号47例(92.15%);增强扫描显示明显强化。
3讨论
老年人容易发生骨质疏松,随着年龄的增加,骨量减少,骨微结果破坏,骨小梁被吸收、变薄细,出现骨小梁厚度与吸收程度失衡,容易发生凹陷[3]。如果不及时补充,随着骨量日益减少,会发展成为小梁骨穿孔,甚至断裂,增加骨折发生率。目前,临床诊断原发性骨质疏松椎体压缩性骨折常用影像学检查包括CT、MRI、X线片等,其中X线操作简单,辐射小,费用低,在基层医院广泛应用[4]。但其诊断准确率低,容易漏诊。MRI对组织分辨率高,并且可多方位成像,在诊断骨组织疏松椎体压缩性骨折中具有一定的优势[5]。
本研究结果显示,X线片检查出观察组椎体骨折72个,以凹陷形为主,椎体骨密度降低占93.05%,椎管变形11.11%,累及终板占30.55%。对照组X线片检出椎体骨折23个,以楔形压缩为主,椎管狭窄占17.39%,累及终板占39.13%。该结论与文献[6]研究结果相似:X线可检查骨质疏松椎体压缩,可显示骨小梁间隙变大,骨密度小,皮质薄。本研究结果显示,MRI检查出观察组椎体后缘上角或下角后翘占97.22%,T1WI序列显示局限性低信号占38.89%,T2WI脂肪抑制序列显示高信号占58.33%。表明MRI诊断原发性骨质疏松椎体压缩性骨折表现为椎体形态改变,椎体信号异常,其中形态方面包括凹陷形压缩为主,T1WI/T2WI椎体内多呈现略高信号特点。对照组MRI检出51个椎体,圆隆状椎体后缘占96.07%,不规则结节状椎体旁软组织肿块占72.54%,骨折病灶T1WI显示弥漫性低信号占86.27%,T2WI脂肪抑制序列显示高信号占92.15%,增强扫描显示明显强化。说明转移瘤继发椎体压缩性骨折患者椎体形态主要为圆隆状椎体后缘,与肿瘤膨胀占位性生长特点有关。
综上所述,X线、MRI可鉴别诊断原发性骨质疏松椎体压缩骨折与转移瘤继发椎体压缩骨折,其中原发性骨质疏松椎体压缩骨折典型征象为椎体后缘上角或下角后翘,而转移瘤继发椎体压缩骨折以椎体后缘圆隆为主。
参考文献:
[1]孙梅兰,刘长安,王宇清,等.椎体成形术生物力学研究进展[J].解放军医药杂志,2016,28(4):113-116.
[2]汤文卫,胡建中,唐圣君,等.椎弓根钉结合椎体成形术治疗椎体压缩骨折[J].湖南师范大学学报(医学),2014,6(1):65-66,73.
[3]陈文静,燕桂新,孙亮,等.128排螺旋CT及MRI对诊断骨质疏松性椎体压缩的诊断价值比较[J].中国CT和MRI杂志,2014,10(6):97-99.
[4]张立兴,梁云川,张斌,等.影像学检查在骨质疏松性椎体压缩骨折诊断及治疗中的价值[J].中国医药导报,2013,10(8):105-107.
[5]曾旭,董国礼,高才良,等.椎体压缩骨折的MR征象在鉴别良恶性病因诊断中的价值[J].中国CT和MRI杂志,2014,9(2):55-57,71.
[6]徐妍妍,李斌,邹海波,等.X线、CT、MRI在评估症状性骨质疏松椎体压缩骨折手术治疗中的价值[J].中华医学杂志,2014,94(11):832-835.
收稿日期:2019-11-18;修回日期:2019-11-28
编辑/王朵梅