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

Classification and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI

BACKGROUND:Some scholars have classified osteoporotic vertebral compression fractures based on X-ray and MRI findings.However,little is reported on the morphological types and distribution rules of fracture areas in osteoporotic vertebral compression fractures.OBJECTIVE:To investigate and summarize the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures based on CT multi-planar reconstruction and MRI.METHODS:Clinical data from 352 patients with osteoporotic vertebral compression fractures,73.07 years of age,including 69 males and 283 females admitted at the First Affiliated Hospital of Guangzhou University of Chinese Medicine from September 2011 to June 2017 were retrospectively reviewed.After admission,CT multi-planar reconstruction,MRI and bone mineral density measurements were conducted in each patient.Fresh osteoporotic vertebral compression fractures were confirmed in 477 vertebrae according to clinical manifestations and imaging findings.Fracture areas were defined as shade compact or bright line based on CT multi-planar reconstruction or bone marrow edema on the MRI.Morphological type and distribution of fracture areas were recorded by two experienced spinal surgeons and one senior radiologist independently.The study protocol was approved by the Ethic Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine in China with an approval No.ZYYECKYJ[2017]057.RESULTS AND CONCLUSION:Fracture areas of 472 vertebrae were indicated distinctly on the MRI,whereas the fracture areas of 5 vertebrae were unclear.Meanwhile,fracture areas of 469 vertebrae were shown clearly on the CT multi-planar reconstruction,but the areas of 8 vertebrae were obscure on the CT.Fracture areas of 5 vertebrae were unclear in both CT and MRI.There was no significant difference between CT and MRI in the observation of fracture areas(P=0.402).Finally,fracture areas of 8 vertebrae could not be described accurately on CT,MRI or both.In the sagittal plane of CT and MRI,morphological types of fracture areas of 469 vertebrae were divided into impacted fracture area(n=311,66.31%)and cleft fracture area(n=158,33.69%).Of the 158 cleft fracture areas,26 vertebrae contained gas,28 vertebrae contained liquid,and 7 vertebrae included both gas and liquid.Of the 469 vertebrae,the location of fracture areas was divided into 5 types:superior(n=238,50.75%),inferior(n=80,17.06%),anterior(n=21,4.48%),central(n=110,23.45%)and mixed(n=20,4.26%).These findings indicate that the morphological types and distribution of fracture areas in fresh osteoporotic vertebral compression fractures can be effectively distinguished by CT multi-planar reconstruction and MRI,which is important for early diagnosis and further treatment of fresh osteoporotic vertebral compression fractures.