MRI对脊柱外伤及原发性骨质疏松椎体压缩时间及功能预后的评估

背景脊椎骨折碎骨片可进入椎管造成神经功能损伤,损伤后神经功能的恢复主要取决于原发性损伤的性质和程度,并与脊髓受损的范围有关.早期影像学的分析可评价脊髓损伤的程度和范围,初步评价患者的治疗手段和预后.目的探讨MRI对脊柱外伤及原发性骨质疏松椎体压缩性骨折的功能预后评估价值,为早期康复介入干预提供依据.设计以良性椎体压缩性骨折患者为研究对象的病例回顾性研究.单位河南省鹤壁矿务局总医院的影像科,两所大学医院的放射线科.对象北京医科大学第一医院、新乡医学院第一附属医院经MRI行脊椎检查者125例,对诊断为良性椎体压缩骨折且临床资料完整者107例(123个椎体),外伤组65例(71个椎体),骨质疏松组42例(52个椎体),进行回顾性分析.方法对107例(123个椎体)由急性外伤或原发性骨质疏松所致的压缩椎体的MRI征象进行对比分析.分别由两名副主任医师对患者的影像学资料进行盲法评价,根据变形椎体前后高度差别及形状将椎体压缩定位"楔形"、"扁形"2种,并观察有或无骨碎片及典型的骨折线.结果变形椎体内完全保留骨髓信号并混有高信号,椎体后上角突向椎管;T1椎体终板下带状低信号;椎体前后缘外形正常或略凹陷、边缘光滑;椎体静脉显示清晰是骨质疏松压缩的MRI表现.椎体较为均匀的低信号并部分保留骨髓信号、椎体变形明显、椎旁血肿、有骨折线或多伴脊髓水肿、囊变是外伤性压缩的MRI表现.椎体强化是骨折修复期的重要表现,是判定新鲜、陈旧骨折的一个参考标准.结论脊柱外伤及原发性骨质疏松椎体骨折及骨折时间的判定可通过MRI进行鉴别,并可初步评价患者的功能和预后.

MRI evaluation on the time and function prognosis of vertebral compression induced by spinal trauma or primary osteoporosis

BACKGROUND: The bone fragments from spinal vertebral fracture can enter into vertebral canal to cause neural functional injury. The restoration of neural function after injury is mainly determined by the character and extent of primary injury, and is related with the spinal injured range. Early imageological analysis can evaluate the degree and range of spinal injury to preliminarily evaluate the therapeutic method and prognosis of the patient.OBJECTIVE: To explore the merit of MRI in the evaluation of function prognosis in compressive fracture induced by spinal trauma or primary osteoporosis to provide a gist for early rehabilitative intervention.DESIGN: A case retrospective study by employing patients with benign vertebral compressive fracture as subjects.SETTING: Department of Imageology of Henan Provincial Hebi Mineral Bureau General Hospital, Department of Radiology of affiliated hospitals of two universities.PARTICIPANTS: Totally 107 cases(123 vertebras) of benign vertebral compressive fracture with complete clinical data including 65 cases of trauma (trauma group, 71 vertebras) and 42 cases of osteoporosis(osteoporosis group, 52 vertebras) were selected from 125 spinal MRI testees of the first affiliated hospital of Beijing Medical University and the first affiliated hospital of Xinxiang Medical College for retrospective analysis.INTERVENTIONS: MRI images of the compressive vertebras in 107 cases (123 vertebras) induced by acute trauma or primary osteoporosis were comparatively analyzed by two vice botanic physicians with blindness method.Vertebral compression was classified into "wedge-shaped" or "flat-shaped" based on the difference between anterior and posterior height of the deformed vertebras and the shapes to observe whether there was bone fragment or not and typical fracture line.RESULTS: MRI manifestation of osteoporosis compression: medullary signal was completely kept in the deformed vertebras with the mixture of high signals. The anterior superior angle of vertebra stuck into vertebral canal. Strip low signal was under the endplate of T1 vertebra. The anterior and posterior vertebral border had normal morphology or slightly sucked with smooth margin. Vertebral vein was clearly displayed. MRI manifestation of traumatic compression: vertebra had relatively even low signal and kept partial medullary signals. Vertebra was obviously deformed with para-vertebral hematoma. There was fracture line or usually accompanied with medullary edema, and cystic degeneration. Vertebral enhancement was an important manifestation of fracture rehabilitative stage, which was the indicator for the judgment of fresh or old fracture.CONCLUSION: MRI can differentiate spinal traumatic fracture and primary osteoporosis fracture, judge fracture time, and preliminarily evaluate the function and prognosis of the patient.