新鲜与陈旧骨质疏松性椎体骨折的鉴别诊断

Differential diagnosis of acute from chronic osteoporotic vertebral fractures

[目的]总结新鲜与陈旧骨质疏松性椎体骨折的鉴别要点。[方法]分析骨质疏松性椎体骨折病人的临床及影像学特点。[结果]36例骨质疏松性椎体骨折中,诊断为新鲜骨折23例(64%),陈旧骨折13例(36%)。椎体前高降低(或楔形变)是骨质疏松性椎体骨折最主要的影像学表现。在X线片、CT上,陈旧的骨折椎,常有终板硬化、骨质增生;新鲜骨折椎,可观察到骨折线。在核磁共振检查上,新鲜骨折椎表现为T2高信号,T2脂肪抑制相高信号。67%的骨质疏松性椎体骨折,可以通过病史、临床表现及X线片,鉴别出新鲜或陈旧骨折;33%病例,需通过核磁共振检查进行鉴别。[结论]椎体楔形变基础上伴骨硬化、骨质增生,提示陈旧骨质疏松性椎体骨折;有外伤史,伤后胸、腰背疼痛,且局部叩、压痛与影像检查发现的骨折水平相符时,应高度怀疑新鲜骨折;从X线片或CT上观察到清晰的骨折线,核磁共振上观察到T2脂肪抑制相高信号,可确认为新鲜骨折。

[ Objective ] To investigate the differentiation of acute from chronic osteoporotic vertebral fractures. [ Method ] The clinical presentation,X-ray,CT and MRI of patients with osteoporotic vertebral fractures were evaluated in the study. [ Result] In 36 cases ,64% were identified as acute and 36% with chronic osteoporotic vertebral fractures. The decreased anterior vertebral height was a most important criterium for the diagnosis of osteoporotic vertebral fractures. Degenerative changes on the X-ray film were usually found in chronic fractures. A high intense signal in a specific T2 under eliminating fat tissue was always observed in acute fracture. [ Conclusion] The local hack pain located at the level of the fractured vertebral body suggests an acute vertebral fracture. Degenerative changes occurred in the edged vertebra is indicative of a chronic fracture. The finding of a specific T2 high intense signal under eliminating fat tissue on MRI is a gold standard for the diagnosis of an acute vertebral fracture.