计算机辅助测定椎体序列不规则性对于绝经后骨质疏松妇女椎体骨折的独立预测价值

Predicting value of a computer-based measurement of vertebral alignment irregularity on fracture risk in postmenopausal women

目的评测腰椎前凸程度和(或)椎体序列不规则性对于腰椎骨折危险性是否具有独立的预测价值。方法选择72例绝经后妇女,平均随访7.5年,其中36例随访过程中未发生椎体骨折(对照组),另36例至少发生一个腰椎骨折(研究组)。此两组基础数据在年龄、BMI、L1～L4BMD(DEXA)、吸烟史以及体育锻炼方面均匹配。应用图像分析软件对腰椎侧位X线平片进行分析,评价腰椎前凸程度和椎体序列不规则性。结果基础数据显示,研究组的椎体序列不规则性明显高于对照组(1.5×10-3vs2.0×10-3,P=0.002);而两组间的腰椎前凸程度差异无统计学意义。随访资料显示研究组椎体序列不规则性明显增加(2.8×10-3,P<0.001);而对照组无明显变化(1.4×10-3,P=0.58)。结论计算机测定椎体序列不规则性对椎体骨折有预测价值,而不依赖于BMD,可作为对老年妇女骨质疏松椎体骨折危险性评价的有价值的补充。

Objective To investigate whether the degree of lordosis and/or irregularities in vertebral alignment are the independent contributors to the risk of fragility fractures in the lumbar spine. Methods Seventy-two postmenopausal women were included, 36 of them maintained skeletal integrity （control group） and 36 sustained at least one fracture （research group） in the lumbar spine over a 7.5-year follow up. The baseline of age, BMI, spine BMD L1-L4 （DEXA）, smoking habits and physical activity matched in two groups. The degree of lordosis as well as irregularity of vertebral alignment was assessed on digital lateral X-ray films using image analyzer software. Results At baseline, the irregularity in research group was significantly higher than that in control group （1.5 × 10 ^-3 vs 2.0 × 10^-3 , P=0. 002） ; there was no statistical difference of lordosis between the two groups. The irregularity of vertebral alignment increased in research group （2.8 × 10^- 3, p〈 0. 001）, while maintain unchanged in control group （1.4 × 10 ^-3, P=0.58）. Conclusion This computer-based measurement of vertebral alignment irregularity has predictive value on vertebral fracture, and can serve as a useful supplement to fracture risk assessment in elderly women.