多发性骨质疏松性椎体压缩骨折中新鲜与陈旧骨折椎体的诊断与鉴别诊断

Diagnosis of fresh and old fracture in multiple osteoporotic vertebral compressive fractures

目的总结多发性骨质疏松性椎体压缩骨折中新鲜与陈旧骨折椎体的诊断与鉴别要点。方法分析36例(196个骨折椎体)多发性骨质疏松性椎体压缩骨折患者的病史、症状、体征、骨密度以及X线片和核磁共振成像(MRI)特点。结果本组患者骨质疏松症较严重,骨密度平均为-3.26,病史平均为13.7个月,多无外伤或仅轻微外伤史,疼痛特点为持续性、进行性加重或突然加重,X线特点为多椎体高度降低、骨皮质变薄、骨小梁稀疏、显示模糊。新鲜骨折椎体139个(包括急性骨折椎体82个、亚急性骨折椎体40个和隐性骨折椎体17个),临床表现为突然加重或进行性加重的疼痛,10个(7.2%)椎体棘突压痛、叩击痛定位准确,X线片可见骨折线;MRI上T1WI、T2WI、抑脂像(即STIR)表现为异常信号。陈旧骨折椎体57个(包括49个已愈合椎体和8个延迟愈合或不愈合椎体),已愈合椎体不再出现临床症状,X线片显示压缩程度较严重,前缘及两侧多有骨质增生或椎体终板硬化。延迟愈合或不愈合骨折椎体引起的疼痛与体位变化有关,腰背部疼痛弥散,X线可见椎体内出现低密度透亮裂隙,MRI上T1WI为极低信号,T2WI上为明显高信号透亮带,周围有低信号带包绕。结论有外伤史,伤后疼痛,棘突叩压痛且与影像检查发现的骨折相符时,应高度考虑新鲜骨折;X线片、MRI检查有清晰骨折线可确认新鲜骨折;患者临床症状、体征明显或X线检查发现椎体形态改变时应行MRI检查,鉴别新鲜或陈旧骨折;对于陈旧骨折,需确认骨折是否愈合。

Objective To sum up the essentials of diagnosis and differential diagnosis of fresh and old fracture in multiple osteoporotic vertebral compresstion fractures. Methods The medical history,symptoms,signs,bone mineral density,X-ray film and MRI were evaluated in 36 cases with 196 fractured vertebral bodies. Results Patients with multiple vertebral compression fractures suffered severe osteoporosis with bone mineral density T score-3. 26. Mean symptomatic history was 13. 7 months,without or with slight trauma history. Symptoms were progressively with suddenly increased back pain. The main radiographic characteristic was height reduction in multiple vertebrae,with trabeculae loss, cortical thickness reduction and increased lucency. 139 fracture vertebral bodies consist of 82 acute fracture bodies,40 subacute fracture bodies and 17 recessive fracture bodies. 10 vertebral bodies （ 7. 2% ） with spinous process tenderness and percussion pain showed visible fracture line in X-Ray film and abnormal signals on MRI. 57 old fracture vertebral bodies consist of 49 healed fracture bodies and 8 delayed union or non-union fracture bodies. Healed vertebral bodies usually had osteophytes or endplate osteosclerosis. Delayed union or nonunion fracture accompany with diffusibility back pain. Delayed union or non-union fracture bodies showed abnormal signal in MRI and fracture lines on X-ray. Conclusion Back pain after trauma history with spinous process rapping,tenderness and special imaging change,should be highly considered fresh fractures. The fracture lines is a good sign for diagnosis of fresh fracture. Healed or nonunion fracture should be distinguished in old fractures.