胸腰段椎体变形和骨质疏松性骨折的相关性研究

Correlation between quantitative morphometric analysis of thoraco-lumbar vertebra and osteoporosis fracture

目的 研究胸腰段椎体变形与骨质疏松性骨折的相关性.方法 测量椎体前缘高度（Ha）、后缘高度（Hp）、中部高度（Hm）和椎间盘高度（Hd）,得出前压楔（Ha/Hp）、后压楔（Hp/Hpp）、中间凹陷改变（Hm/Hp、Hd/Ha）及椎体压缩率（Hp-Ha/Hp、Hp-Hm/Hp、Hpp-Hp/Hpp）.比较患有脆性骨折的60岁以上患者与30～50岁及同年龄无骨折人群的胸腰段椎体平均变形率.分组比较各组间胸腰段椎体平均变形率：骨密度≤-2.5SD但无脆性骨折患者7例（A组）;临床上患有脆性骨折但骨密度正常患者8例（B组）;既有脆性骨折又有骨密度≤-2.5SD患者10例（C组）.结果 （1）60岁以上患有脆性骨折患者与同年龄及30～50岁无脆性骨折人群相比,胸腰段椎体变形率指标除Hp/Hpp、Hpp-Hp/Hpp外,其余多个指标的比较均有统计学意义（均P〈0.05）.（2）既有脆性骨折又有骨密度≤-2.5SD组（C组）与骨密度测定≤-2.5SD但临床上无脆性骨折组（A组）比较,Hd/Ha、压缩率的差异有统计学意义（均P〈0.05）;其余指标的两两比较均无统计学意义（均P〉0.05）.结论 椎体的变形率与脆性骨折的发生有有密切的关系,比骨密度指标更为敏感,可考虑参考胸腰段椎体变形率与骨密度测定结果来综合评估脆性骨折的发生风险.

Objective To investigate the correlation between morphological changes thoraco-lumbar vertebral-body and osteoporosis fracture, Methods A standard lateral thoraco-lumbar （T-L） spine radiography was performed by centering the X-ray at L1. Vertebral heights （anterior： Ha, middle： Hm and posterior： Hp）, disc height （Hd） and 4 vertebral ratios （anterior wedging： Ha/Hp, central wedging： Hm/Hp, posterior wedging： Hp/Hpp and Hd/Ha） and vertebral compression index （Hp-Ha/Hp, Hp-Hm/Hp, Hpp-Hp/Hpp） were acquired. Thoraco-lumber vertebral changes were compared between the patients aged 30～50y and ≥60y with fragile fracture. Thoraco-lumber vertebral changes were compared between patients at ≥60 y between with and without fragile fracture. Thoraco-lumber vertebral changes were compared among groups： 7 cases with bone mineral density （BMD）≤-2,5SD and without fragile fracture（group A）, 8 cases with BMD 〉-2.5SD and with fragile fracture（group B）, 10 cases with BMD ≤-2.5SD and fragile fracture （group C）. Results In the comparisons between the patients at ≥60 y with and without fragile fracture and the patients at 30 ～ 50 y, the morphological changes of thoraco-lumber vertebral were significant （P 〈0.05）, except Hp/Hpp, Hpp-Hp/Hpp. In the comparisons between cases with BMD ≤-2.5SD with and without fragile fracture, Hd/Ha and scores changes were significant （P〈0.05）. Conclusion The morphological changes of thoraco-lumber vertebral are closely correlated with fragile fracture, and are more sensitive than BMD, which suggests that the risk of fragile fracture can be assessed by combination of BMD with the morphological changes of thoraco-lumber vertebral.