骨质疏松性椎体骨折MRI表现与后凸成形术疗效相关性分析

The correlation between the clinical effects in the treatment of vertebral compression fractures with percutaneous kyphoplasty and MRI findings of osteoporotic vertebral compression fractures

目的探讨骨质疏松性椎体压缩骨折MRI影像学改变与PKP疗效的相关性。方法收集行椎体后凸成形术治疗的骨质疏松性椎体骨折(OVCFs)患者的病历资料34例。依据影像学表现将椎体骨折分为楔型(A组)、凹陷型(B组)、扁平型(C组)3类,记录手术前后VAS值,测量术前术后椎体高度及后凸Cobb角的变化,测量信号强度,计算信号强度比。比较不同类型椎体骨折疼痛情况、手术前后椎体高度及后凸Cobb角的变化,探讨椎体信号强度比与疼痛的相关性。结果所有患者术后腰背部疼痛症状均明显缓解,患者手术前后VAS评分差异有统计学意义(P<0.05)。A组局部后凸Cobb角在手术前后差异有统计学意义(P<0.05),B、C组手术前后Cobb角差异无统计学意义(P>0.05)。3组术后椎体平均高度恢复率差异有统计学意义(P<0.05),伤椎MRI信号强度比与疼痛存在相关性(P<0.05)。结论椎体骨折MRI表现对后凸成形术(PKP)疗效具有一定预测性,楔型、扁平型椎体骨折行PKP后椎体高度恢复较凹陷型好。伤椎水肿信号强度与疼痛存在相关性,水肿信号强的椎体骨折对PKP治疗反应较好。

Objective To explore the correlation between the clinical effects in the treatment of vertebral compression fractures（OVCFs） with percutaneous kyphoplasty and MRI findings of osteoporotic vertebral compression fractures.Methods 34 Patients with OVCF were operated by PKP.The patients were divided into three groups according to the sharp on Image,including wedge fracture（group A）,concave fracture（group B） and flat fracture（group C）.The visual analog scale（VAS）,kyphosis Cobb angle and vertebral height were recorded in preoperation and postoperation.The signal intensity on MRI of fractures vertebral body and calculate the rate of signal intensity were measured and the VAS in different kinds OVCFs and vertebral height and kyphosis Cobb angle were compared among three groups.The correlation between the rate of signal intensity on MRI and VS A was investigated.Results The pain of all patients had relieved.The VSA had statistically difference between preoperation and postoperation.The VSA had no statistically difference in preoperation and postoperation.The kyphosis Cobb angle had statistically difference between preoperation and postoperation in the group A（P 0.05）,there was no statistically difference between preoperation and postoperation in the group B and C.Each part of all vertebral body height had improved after operation.The vertebral body height restoration rate had statistically difference in group B and group A.It had no statistically difference in groups A and C.The height restoration of anterior border and middle were obvious in group A and group C.In the group B,the middle height restoration of vertebral body was obvious.There was correlation between the rate of signal intensity on MRI and the VSA.Conclusion MRI findings of osteoporotic vertebral compression fractures can predict the clinical effects in the treatment of vertebral compression fractures with percutaneous kyphoplasty.The wedge fracture and flat fracture are better than concave fracture in vertebral body height restoration.The rate of signal intensity on MRI is related to back pain.