断层成像技术对脊柱创伤的诊断价值

目的：探讨断层成像技术MRI在脊椎骨折和脊髓损伤中的诊断价值.方法：回顾性分析89例脊柱创伤患者的临床和MRI资料,MRI检查使用1.5T扫描仪,行矢状位T1WI和T2WI、横切位T2WI、脂肪抑制（STIR）扫描.结果：89例中,骨挫伤3例、小骨折5例、Chance骨折4例、单纯性脊椎压缩性骨折33例、爆裂骨折26例、骨折脱位18例,合并脊髓损伤43例 脊椎骨折和脊髓损伤分别具有较为特征性的MRI表现.结论：断层成像技术MRI可清晰地显示脊椎骨挫伤、骨折、脱位、椎管狭窄、椎间盘突出、韧带损伤和脊髓损伤,对脊柱创伤的诊断有重要价值.     

Diffusion weighted MR imaging in acute vertebral compression fractures: differentiation between malignant and benign causes

Aim

The primary objective of this study was to evaluate the specificity and sensitivity of diffusion weighted MR imaging (DWI) in the differentiation and characterisation between benign and malignant vertebral compression fractures compared with conventional T1 WI, T2 WI and fat suppressed contrast enhanced T1 WI in the Malaysian population.

Materials and Methods

Thirty five patients with 68 vertebral compression fractures were imaged using the conventional T1 WI, T2 WI, fat suppressed contrast enhanced T1-weighted, and steady state free precession diffusion-weighted (SSFP DWI) sequences on a 1.5 T MR scanner. Signal intensities were analysed qualitatively for all the sequences by comparison to adjacent normal marrow. A quantitative assessment of the signal intensity in the SSFP DWI was also performed.

Results

T1 WI and T2 WI images are of limited diagnostic value because of the variability in signal intensities. Contrast enhanced images had sensitivity and specificity of 93% and 71%, respectively with a negative predictive value (NPV) of 93%. On diffusion-weighted MR imaging, sensitivity was 87% with specificity of 92%. The positive predicative value (PPV) and NPV were both 90%. The quantitative assessment of ratio revealed a statistical significant difference between the benign (0.96) and the malignant (1.73) group of lesion (Mann-Whitney U-test, p=0.0001).

Conclusions

We found that absence of contrast enhancement has a high NPV (90%) while SSFP DWI has both a high PPV (90%) and high NPV (90%) in detecting malignant vertebral compression fractures. Furthermore, in our study the ratio of lesion intensity technique offers an excellent criterion to differentiate between the benign and malignant lesions, and the presence of iso- or hypointensity of the collapsed vertebral bodies is suggestive of a benign lesion while hyperintensity is highly suggestive of malignancy. We also found that using the NLMR showed a statistical significant difference between the malignant and benign groups (p<0.0001) with osteoporotic and malignant lesions have mean values of 0.96 (SD 0.25) and 1.73 (SD 0.4) respectively.     

Clinical usefulness of magnetic resonance cisternography in patients having hemifacial spasm

To evaluate the usefulness of MR cisternography fourteen patients that had hemifacial spasm and 20 control patients underwent MR cisternography. All the patients with hemifacial spasm had a confirmed vascular compression after surgery. MR cisternography was performed using a 1.5-tesla superconducting MR magnet in which a 3D (dimensional) heavily T2-weighted turbo spin-echo sequence was used. In 34 randomly selected individuals, we retrospectively determined whether MR cisternography images could be used to evaluate symptoms, and what the benefits of obtaining this image was. The results were correlated with the surgical findings. The sensitivity was 100% and the specificity was 94% in all patients having a hemifacial spasm. The offending vessels were the anterior inferior cerebellar artery (AICA) in six patients cases, the posterior inferior cerebellar artery (PICA) in six, both the vertebral artery and PICA in one, and the vertebral artery in one. All the images showed good resolution and contrast, and also showed the exact correlation between the facial nerve and intracranial vessels in the multiplaner image. The findings of neurovascular compression were well correlated with the surgical findings. We believe that high-resolution 3D MR cisternography is a very useful method for evaluating the neurovascular compression in patients that have hemifacial spasm.     

磁共振在儿童椎体骨髓转化及病变中信号类型的初步研究

目的通过分析椎体骨髓磁共振信号类型分布与年龄、性别的关系,探讨正常儿童椎体骨髓转换中磁共振信号的变化规律及其在椎体病变中的应用。方法选择分析105例正常儿童的脊柱椎体磁共振T1加权序列图像,其中男性63例,女性42例,年龄3个月～17岁(平均年龄6.56岁);同时选择血液系统疾病患儿共32例作为病变组对照研究,其中男性18例,女性14例,年龄3～14岁(平均年龄8.09岁)。病种包括各种原因所致贫血(19例)和白血病(13例)。采用GE 0.2 TProfile Gold永磁型开放式磁共振扫描仪进行脊柱矢状位SE T1WI扫描。采用四级六分法对椎体T1WI表现进行分型观察,并对所获得的数据与年龄、性别的关系进行统计学处理。结果不同年龄组间脊柱椎体信号类型分布差异具有显著统计学意义(P<0.01);0～5岁儿童脊柱椎体信号类型主要为Ⅱa、Ⅲ和Ⅳa型,6～17岁儿童脊柱椎体信号类型主要为Ⅳa和Ⅳb型;脊柱椎体信号类型在不同性别间分布差异均具有显著统计学意义(P<0.01);病变组脊柱椎体表现为Ⅰ型弥漫性T1低信号者最常见(75.6%),其他常见类型还包括Ⅱa型和Ⅳa型。结论椎体磁共振T1信号表现类型的分布与年龄及性别密切相关,不同年龄、不同性别间椎体磁共振成像表现具有显著差异。同时,病变组不同年龄段患儿椎体均主要表现为弥漫性T1信号减低。因此,椎体磁共振表现分型研究有助于直观显示骨髓正常发育过程及弥漫性骨髓病变或翻转的发生。     

椎体成形穿刺注射骨水泥防止灾难性并发症：87例137个椎体资料分析

背景：椎体成形治疗老年骨质疏松椎体压缩性骨折效果确切,但一些热点问题仍无定论。 目的：探讨椎体成形技术治疗老年骨质疏松椎体压缩性骨折过程中穿刺损伤、骨水泥注射剂量、多椎体成形及骨水泥渗漏等问题的解决方案。 方法：回顾性分析经皮穿刺椎体成形技术治疗骨质疏松椎体压缩性骨折87例137个椎体。全部经单侧椎弓根穿刺,骨水泥稀薄期注射,骨水泥注射量为3~7.5 mL,胸椎3 mL以上,腰椎4.5 mL以上,平均4.8 mL,多椎体者均一次手术完成。 结果与结论：随访6~30个月,治疗后第2天和最终随访时患者目测类比疼痛评分及Oswestry功能障碍指数评分均显著低于治疗前(P < 0.01)。所有患者胸腰背疼痛明显缓解,其中58例疼痛完全消失;1例术中出现骨水泥单体中毒症状,28例出现不同程度骨水泥渗漏,但未出现临床症状。137个椎体中骨水泥渗透达到和超过中线119个,占87.2%。提示椎体成形技术是治疗老年骨质疏松椎体压缩性骨折的有效方法。骨水泥稀薄期注射能够获得良好的渗透效果;在局麻药限量范围内,一次可完成3个以上椎体成形;严格正规的操作技术是预防骨水泥渗漏灾难性并发症最重要的方法。     

Wedging of vertebral bodies at the thoracolumbar junction in asymptomatic healthy subjects on magnetic resonance imaging

Purpose

Wedging of the vertebral body on radiological examination is a valuable indicator of a vertebral compression fracture, although it can also be observed in subjects with no history of trauma. The purpose of this study was to elucidate the normative value of vertebral wedging at the thoracolumbar junction in asymptomatic healthy subjects for differential diagnosis of vertebral compression fractures using MRI.

Methods

A total of 115 subjects without back pain at the time of the examination and without history of spinal trauma was included (68 males, 47 females, mean age 49.5?years). They underwent MRI of the thoracic and lumbar spine, and the ratio of anterior vertical height to posterior vertical height of the vertebral body (APR) was determined from T10 to L2 on T2 weighted sagittal images.

Results

APR was 0.92?±?0.08 at T10, 0.92?±?0.08 at T11, 0.90?±?0.06 at T12, 0.89?±?0.06 at L1, and 0.90?±?0.07 at L2, indicating that vertebral bodies at the thoracolumbar junction appear wedge-shaped rather than rectangular. Males, thinner subjects, smokers, and subjects with abnormalities of the endplates such as a Schmorl nodule had a significantly smaller APR than females, fatter subjects, non-smokers, and those without endplate abnormalities.

Conclusion

The normative values of APR obtained in the present study can represent a valuable reference in the diagnosis of vertebral compression fracture to help prevent confusion with physiological vertebral wedging.     

脊柱原发骨质疏松性压缩骨折MRI特征及诊断价值

目的　分析脊柱原发性骨质疏松性压缩骨折MRI特点及其诊断价值 .方法　回顾性分析经X线诊断、临床证实的 4 8例脊椎原发骨质疏松性压缩骨折的MRI表现 .结果　共 82个椎体表现为压缩变形 ,其中凹陷形 4 1个 ,楔形 31个 ,扁平形 10个 .矢状位T1WI5 2个椎体表现不同类型的低信号 ,30个椎体未见异常信号 .结论　脊柱原发骨质疏松性骨折的MRI表现较具特征性 ,是临床诊断的一种可靠的检查手段 ,能准确地与恶性肿瘤所致的椎体病理性骨折鉴别     

椎间隙感染的MRI诊断

目的：分析椎间隙感染的MRI影像特征，评价椎间隙感染的MRI诊断价值。方法：对15例经临床或手术病理证实的椎间隙感染患者行脊柱MRI检查，扫描序列为矢状面FrFsE-T1WI、FrFSE-T2WI、脂肪抑制T2WI，横断面FrFSE-T2WI，其中5例行Gd-DTPA增强对比扫描。结果：15例患者共发现17个椎间隙感染，其中15个发生于腰椎间隙。椎间隙狭窄(13个)，病变椎间盘呈不同程度破坏、碎裂，呈长T1(17个)长T2(15个)信号，T2上椎间盘髓核内正常裂隙状低信号消失(13个)，上下相邻椎体受累破坏(15个)，椎旁软组织肿胀(8个)。5例行Gd-DT-PA增强对比扫描可见病变椎间盘、相邻椎体及椎旁软组织异常强化。结论：MRI对诊断椎间隙感染具有很高的敏感性和准确性，应作为首选的影像学检查方法：     

骨骼肌系统感染的MRI诊断价值

骨骼肌系统感染，于MRI T1 WI上多低信号、T2W1上多高信号。骨髓炎时，T1WI上病灶内低信号，可由纤维化造成。炎性肿块T1WI上高信号可由出血引起，而T2WI上肿块内低信号也可由纤维组织形成产生。STIR成像对显示骨骼肌系统病变有高度敏感性。Gd-DTPA增强后，感染病灶内环状强化是提示脓肿形成或组织坏死液化。骨骼肌系统感染，MRI优于X线平片检查，但类似上述MRI表现也可见于骨骼肌系统的其他良性或恶性病史。因此，必须结合临床资料才能正确诊断。     

Magnetic resonance imaging of the bone marrow after bone marrow transplantation or immunosuppressive therapy in aplastic anemia.

To compare magnetic resonance (MR) images of the bone marrow (BM) after bone marrow transplantation or immunosuppressive therapy in patients with aplastic anemia (AA), MR imaging of BM was reviewed retrospectively in 16 patients (13 males and 3 females, mean age 26 yr) with AA who completely responded clinically after transplantation or immunosuppressive therapy. The signal intensity (SI) of BM was classified into four patterns according to the increasing amount of cellular marrow, i.e., pattern I to IV. SI of MR imaging of BM exhibited an increase of cellular marrows following both transplantation and immunosuppressive therapy. Of the eight patients on transplantation, the SI of the lumbar spinal BM was pattern III in two patients and IV in six on T1-weighted and short tau inversion recovery (STIR) images. In the eight patients with immunosuppressive therapy, the SI of the lumbar spinal BM was pattern II in one, III in five, and IV in two on T1-weighted images and pattern II in one, III in four, and IV in three on STIR images. SI on MR imaging of the lumbar spinal BM showed a more cellular pattern in patients on transplantation than in those on immunosuppressive therapy.     

不同时间骨质疏松性椎体压缩骨折的经皮椎体成形治疗

背景：近年来应用经皮椎体成形治疗老年骨质疏松性椎体压缩骨折的技术正在逐步开展,但其治疗不同骨折时间患者的疗效还存在争议。 目的：对比经皮椎体成形治疗不同骨折时间骨质疏松性椎体压缩骨折的临床疗效。 方法：回顾性分析随访资料完整的行经皮椎体成形治疗的骨质疏松性椎体压缩骨折病例91例(127节椎体)。按照受伤或疼痛发生到手术时间将病例分为3组：伤后3周内组、伤后3周-6个月组、伤后6个月以上组,比较3组经皮椎体成形治疗后疼痛缓解、日常生活能力恢复及椎体高度恢复情况。 结果与结论：①3组治疗后疼痛明显缓解,且随着时间的延长疼痛逐渐减轻(P < 0.01)。伤后3周内组与伤后3周-6个月组治疗后不同时间点疼痛缓解情况明显优于伤后6个月以上组(P < 0.01),前两组组间比较差异无显著性意义。②3组治疗后日常生活能力评分明显提高,且随时间延长逐步提高(P < 0.01)。不同时间点组间比较：伤后3周内组>伤后3周-6个月组>伤后6个月以上组(P < 0.01)。③治疗前椎体前缘及中间高度比较,3组未见明显差别;治疗后3d椎体前缘及中间高度比较,伤后3周内组>伤后3周-6个月组>伤后6个月以上组(P < 0.01)。治疗前及治疗后3d各组椎体后缘高度差异无显著性意义。表明经皮椎体成形治疗对于伤后6个月以上陈旧性骨折的疗效较差。     

经皮椎体成形修复非骨质疏松单节段椎体创伤性压缩骨折

BACKGROUND: It is still controversial about whether percutaneous vertebroplasty can be as an option for treatment of non-osteoporotic single-segmental vertebral traumatic compression fractures.OBJECTIVE: To observe the effect of percutaneous vertebroplasty in repair of non-osteoporotic single-segmental vertebral traumatic compression fractures.METHODS: Totally 20 patients who underwent percutaneous vertebroplasty in repair of non-osteoporotic single-segmental vertebral traumatic compression fractures between March 2010 and January 2013 were collected. The variation of visual analog scale scores and the Oswestry disability index scores of patients was observed before and after the repair.RESULTS AND CONCLUSION:(1) The visual analog scale scores and the Oswestry disability index scores of patients were significantly reduced after repair compared with those before repair, moreover, the visual analog scale scores and the Oswestry disability index scores of patients at the 3, 6, 12 and 18 months after repair were similar. (2) All patients had no adverse effects and complications. (3) These results suggest that percutaneous vertebroplasty in repair of non-osteoporotic single-segmental vertebral traumaticcompression fractures quickly      

基于CT多平面重建及MRI分析新鲜骨质疏松性椎体压缩骨折椎体内骨折区域形态类型及分布规律

文题释义： 骨质疏松症：是一种以骨量低下、骨微结构破坏导致骨脆性增加，易发生骨折为特征的全身性骨病。骨质疏松症分为原发性和继发性2大类，原发性骨质疏松症又分为绝经后骨质疏松症、老年性骨质疏松症和特发性骨质疏松症3种。继发性骨质疏松症通常由后天多种因素(物理、力学、化学)或疾病所致。双能X射线骨密度T值≤-2.5SD即可诊断为骨质疏。 胸、腰椎体压缩性骨折的诊断：胸、腰椎体压缩性骨折是骨质疏松常见并发症之一，X射线是诊断胸、腰压缩性骨折的首选检查方式，其有利于观察脊柱序列的连续性，可同时观察整个胸腰段以及更多椎体受伤情况，例如椎体的高度、宽度、楔形改变以判断骨折压缩的程度，但难以显示骨细微结构变化。CT检查可从冠状面、矢状面、横断面显示椎体三柱情况，但对椎管内外软组织显示不如MRI。MRI可有效鉴别陈旧及新鲜椎体压缩性骨折，同时可鉴别椎体良性及恶性病变；此外，MRI对于脊髓、神经损伤、椎管内病变等准确性高于CT，但显示骨折线、小关节骨折或脱位等不及CT。 背景：既往有学者根据X射线、MRI等对骨质疏松性椎体压缩骨折进行分类，然而目前国内外关于骨质疏松性椎体压缩骨折中椎体内骨折区域的形态类型及分布规律的研究鲜有报道。 目的：应用CT多平面重建及MRI观察并总结新鲜骨质疏松性压缩骨折椎体内的骨折区域形态类型及分布规律。 方法：回顾性分析2011年9月至2017年6月广州中医药大学第一附属医院收治的352例骨质疏松性椎体压缩骨折患者的临床资料，其中男69例，女283例，平均年龄73.07岁。入院后所有患者完善X射线、CT多平面重建、MRI及骨密度等检查，根据患者临床症状及影像学检查确诊477个椎体为新鲜骨质疏松性压缩骨折。将多平面重建CT中致密影或透亮线及MRI中骨髓水肿带定义为骨折区域，由2名脊柱外科医师及1名影像科医师通过多平面重建CT及MRI观察并总结骨折区域的形态类型及分布规律。研究已获得广州中医药大学第一附属医院伦理委员会批准，批准号：ZYYECKYJ【2017】057。 结果与结论：①MRI可清晰显示472个椎体内骨折区域，不能清晰显示5个椎体内骨折区域；多平面重建CT可清晰显示469个椎体内骨折区域，不能清晰显示8个椎体内骨折区域，其中包括MRI中无法分析骨折区域的5个椎体；两种检查方法观察骨折椎体内骨折区域无明显差异(P=0.402)，最终发现8个椎体不能通过CT或MRI判断其骨折区域形态；②以矢状面CT、MRI图像为主观察469个椎体，骨折区域形态类型分为嵌插型(n=311，66.31%)和裂隙型(n=158，33.69%)，在裂隙型椎体中，26个椎体裂隙内含有气体，28个椎体裂隙内含有液体，7个椎体裂隙内同时存在气体和液体；③以矢状面CT、MRI图像为主观察469个椎体，骨折区域在椎体内的分布位置分为上方型(n=238，50.75%)、下方型(n=80，17.06%)、前方型(n=21，4.48%)、中央型(n=110，23.45%)、混合型(n=20，4.26%)；④结果表明，结合多平面重建CT及MRI能有效辨别椎体内骨折区域形态类型及明确骨折区域在椎体内分布情况，这对于分析新鲜骨质疏松性椎体压缩骨折受伤机制及制定治疗方案有一定的指导意义。 ORCID: 0000-0002-2990-7592(莫凌) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程     

Influence of age and gender on thoracic vertebral body shape and disc degeneration: an MR investigation of 169 cases

There are limited data detailing the pattern of age and gender-related changes to the thoracic vertebral bodies and intervertebral discs. A retrospective MR investigation, involving T1-weighted midsagittal images from 169 cases, was undertaken to examine age influences on the anterior wedge (anteroposterior height ratio or Ha/Hp), biconcavity (midposterior height ratio or Hm/Hp), and compression indices (posterior height/anteroposterior diameter or Hp/D) of the thoracic vertebral bodies. Disc degenerative changes in the annulus, nucleus, end-plate and disc margin were noted on T2-weighted sagittal images for the 169 cases, based on a 3-level grading system. A linear age-related decline in the Ha/Hp and Hm/Hp indices was noted. The Hp/D index increased during the first few decades of life, then decreased gradually thereafter. The prevalence of abnormal findings in the annuli, nuclei and disc margins increased with increasing age, particularly in the mid and lower thoracic discs. Greater disc degenerative changes were observed in males. These findings provide further insight into the nature of thoracic vertebral shape changes across the lifespan, and the typical patterns of degeneration of the thoracic intervertebral discs.     

Anterior spinal column augmentation with injectable bone cements

A vertebral fracture, whether originating from osteoporosis or trauma, can be the cause of pain, disability, deformation and neurological deficit. The treatment of vertebral compression fractures has, for many years until the advent of vertebroplasty, consisted of bedrest and analgesics. Vertebroplasty is a percutaneous technique during which bone cement is injected in a vertebral body to provide immediate pain relief by stabilization. Inflatable bone tamps can, prior to the injection of cement, be used to create a void in the vertebral body, in which case the technique is known as balloon vertebroplasty (or kyphoplasty). The chance of extracorporal cement leakage is smaller for balloon vertebroplasty than for vertebroplasty. Some authors also claim to have gained some correction in vertebral body height or angulation. Both interventions can be used for several indications, including osteoporotic compression fractures and osteolytic lesions of the vertebral body such as myeloma, hemangioma or metastasis, and also for traumatic burst fractures in combination with pedicle screw instrumentation. Polymethyl methacrylate cement is the bone void filler that is used most frequently, although the application of calcium phosphate cements has been studied widely in vitro, in vivo and also in small-scale clinical series. The clinical results of (balloon-) vertebroplasty are favorable with 85-95% of all patients experiencing immediate and long-lasting relief of pain. Serious complications are relatively rare but include neurological deficit and pulmonary embolism. In this paper, both vertebroplasty and balloon vertebroplasty and their respective indications, techniques and results are described in relation with the application and limitations of permanent and resorbable injectable bone cements.     

人工骨复合物与经伤椎螺钉置入修复胸腰椎骨折可促进新骨形成

背景：单纯伤椎置钉疗法治疗胸腰椎骨折具有较好的疗效,但存在一定不足,如对于重度压缩或爆裂骨折适用性差、伤椎痛感强、易造成伤椎创面失神经支配和椎旁肌损伤及恢复较慢等。 目的：观察人工骨复合物并伤椎螺钉置入修复胸腰椎骨折的临床效果。 方法：纳入126例胸腰椎压缩骨折患者,其中对照组62例采用常规伤椎放置椎弓根螺钉方法治疗,试验组64例采用人工骨复合物联合伤椎放置椎弓根螺钉方法治疗。随访X射线观察两组骨折愈合、椎体前缘高度百分比、矢状位Cobb角及修复6个月后椎体高度丢失率变化。 结果与结论：所有患者均获得随访,修复后12-16个月,两组骨折椎体愈合完全。修复后1周,两组椎体前缘高度与矢状位Cobb角均较修复前改善(P < 0.01),两组间椎体前缘高度与矢状位Cobb角比较差异无显著性意义(P > 0.05);修复6个月后,试验组在伤椎创面可见明显新骨生成,患者基本无痛感,对照组新骨生成较慢,患者仍有痛感,两组椎体前缘高度丢失量与矢状位Cobb角矫正丢失量比较差异均无显著性意义(P > 0.05)。表明人工骨复合物联合伤椎置钉修复胸腰椎骨折促进新骨形成,有利于患者恢复。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

单侧与双侧入路PVP治疗骨质疏松性椎体压缩骨折的近期临床疗效观察

目的比较单侧与双侧经椎弓根入路经皮椎体成形术(percutaneous vertebroplasty,PVP)治疗骨质疏松性椎体压缩骨折的临床疗效。方法回顾性分析2016年1月至2018年5月于我院行PVP治疗的78例单个椎体骨质疏松性椎体压缩骨折患者资料,根据手术入路不同分为两组:单侧组33例,男6例,女27例,年龄56～100岁,平均(74.2±9.6)岁;双侧组45例,男6例,女39例,年龄57～94岁,平均(75.0±8.3)岁。统计分析两组患者的疼痛视觉模拟评分(VAS)、手术时间、骨水泥注入量、骨水泥渗漏率、手术前后骨折椎体压缩程度、手术前后骨折椎体后凸Cobb角、术后骨折椎体前缘高度恢复率及后凸Cobb角恢复率。结果两组患者术后疼痛症状均较术前明显改善,组内术后VAS评分均明显低于术前,差异有统计学意义(P0.05);但两组间术后VAS评分差异无统计学意义(P0.05)。单侧入路组平均手术时间(56.9±29.7) min较双侧入路组(71.1±25.7) min短,骨水泥平均注入量(2.6±1.0) mL较双侧入路组(4.1±1.1) mL少,差异有统计学意义(P0.05)。单侧入路组骨水泥渗漏率18.2%(6/33)略高于双侧入路组15.6%(7/45),但两组差异无统计学意义(P0.05)。两组术后椎体压缩程度及后凸Cobb角均较术前改善,差异有统计学意义(P0.05),但两组间术后椎体高度恢复率及后凸Cobb角恢复率差异均无统计学意义(P0.05)。结论采用单侧与双侧经椎弓根入路PVP治疗骨质疏松性椎体压缩骨折,均能取得良好的治疗效果,但单侧入路组手术时间短、穿刺损伤小。     

正常胎儿标本腰椎发育的磁共振研究

目的　研究正常胎儿标本椎体、椎管在不同孕周的发育表现及生长曲线。 方法　52例15～40孕周的胎儿标本接受3.0T磁共振T2WI腰椎横轴位和冠状位扫描;观察及测量内容： ①L1椎间盘信号及高度变化;②L2椎体、骨化中心高度和面积及其相应水平椎体、椎管前后径和面积。对上述测量结果和孕周间作回归分析。 结果　①L1椎间盘在小于或等于21周时为低信号,21周后逐渐为高信号,其高度随孕周呈线性增长(P<0.01);②L2椎体及骨化中心的高度、面积随孕周呈线性增长(P<0.01),骨化中心与椎体面积比值随孕周增大(P<0.01);L2椎体前后径与相应水平椎管前后径比值范围为1:1.3到1:0.6。 结论　磁共振可明确显示胎儿椎体、椎间盘、椎管在不同孕周的发育表现及变化规律。     

骨密度影像学测量与椎体骨折率评估结合提高骨质疏松的诊断率

背景：临床上用于诊断骨质疏松症的通用指标：脆性骨折或骨密度T ≤ -2.5标准差,只要满足一个条件即可作出骨质疏松的诊断。在做骨密度检查时同时进行椎体骨折评估,可以避免单一因素的评判造成骨质疏松症的漏诊,有利于提高骨质疏松的诊断率。 目的：评估骨密度结合椎体骨折对骨质疏松症临床诊断率的影响。 方法：对217例年龄≥50岁的绝经后女性患者行髋部骨密度检测,同时进行椎体骨折评估,比较单纯依靠骨密度检查与骨密度结合椎体骨折评估对骨质疏松的诊断率的影响,同时探讨骨密度对椎体骨折率的影响。 结果与结论：92例骨密度T ≤ -2.5,达到骨质疏松诊断阈值,占42.4%;102例骨密度-1 > T > -2.5,为低骨量,占47.0%;23例骨密度在正常范围,骨密度T > -1,占10.6%。158例无椎体骨折;59例(27.2%)椎体骨折,101个骨折椎。骨密度T > -2.5的患者椎体骨折率为21.6%,骨密度T ≤ -2.5的患者椎体骨折率34.8%,两组骨折率比较差异有显著性意义(P < 0.05);骨密度结合椎体骨折评估的骨质疏松诊断率为54.8%,比单纯依靠骨密度检查,骨质疏松诊断率提高12.4%(P=0.01)。说明绝经后女性做骨密度检测的同时进行椎体骨折评估可以提高骨质疏松的诊断率。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

伤椎椎弓根置钉治疗胸腰椎压缩性骨折的三维有限元分析

背景：有文献报道伤椎置钉技术较传统4钉跨阶段固定具有更强的牢固性,可有效避免内固定的松动断裂,但其生物力学机制研究尚显不足。 目的：构建脊柱胸腰椎单纯压缩性骨折的三维有限元模型,探讨伤椎附加椎弓根螺钉置入治疗胸腰椎压缩性骨折的生物力学效应。 方法：将一T12椎体压缩性骨折患者脊柱胸腰段超薄CT扫描数据输入Mimics软件中,构建T12椎体压缩性骨折的有限元模型,在此模型基础上模拟伤椎置6钉和跨节段4钉内固定,对两个模型分别施加垂直压缩、前屈、后伸、左屈及右旋载荷。 结果与结论：两组固定模式各种载荷下的应力均集中在螺钉根部,在垂直载荷下,螺钉的应力最小,右旋和左屈载荷下的应力最大;在垂直压缩、前屈、后伸、左侧弯及右旋运动下,上位螺钉较下位螺钉应力大(P < 0.05)。伤椎置6钉固定组螺钉应力较跨节段4钉固定组小(P < 0.05)。两组T11椎体最大位移无差别。表明伤椎附加椎弓根螺钉置入可以优化内固定的载荷,减少断钉率。