椎体压缩性骨折愈合过程中骨痂骨密度变化及其临床意义

Changes of BMD in callus during vertebral compression fracture healing and its clinical significance

目的观察椎体压缩性骨折骨痂骨密度变化与病程长度的关系,探讨双能X线骨密度仪术前定位陈旧性椎体骨折不愈合的可行性。方法本院2013年1月至2016年1月采用椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗腰1椎体压缩性骨折(均经磁共振成像或SPECT-CT明确诊断)患者66例,年龄60~80岁,均为绝经后女性。按病程长度分为A组(对照组)、B组(新鲜骨折组)、C组(亚急性期骨折组)、D组(陈旧性骨折不愈合组)。运用方差分析观察骨密度比率(腰1椎体骨密度/腰2椎体骨密度×100%)与病程长度的关系。结果各组间年龄、身高、体重差异无统计学意义(P>0.05),各组间骨密度比率差异有统计学意义(F=34.839,P<0.05),在各组多重比较中,A组与B组间差异无统计学意义(P>0.05),其余两组间差异有统计学意义(P<0.05)。结论椎体压缩性骨折骨痂骨密度随病程延长而增加,陈旧性骨折不愈合期骨痂骨密度较邻近椎体明显增高,在条件有限的情况下,双能X线骨密度仪不失为术前定位"责任椎"的一种好方法。

Objective To study the relationship between bone mineral density（BMD） and time length of disease in vertebral compression fractures,and to explore the feasibility of DEXA for localized vertebral fractures.Methods From January 2013 January to 2016 January,66 60-80-year-old women with the first lumbar vertebral compression fracture（diagnosed by MRI or SPECT-CT） received percutaneous kyphoplasty（PKP） treatment in our hospital.According to the duration of the fracture,patients were divided into Group A（Control group）,group B（fresh fracture group）,group C（subacute fracture group）,and group D（old fracture group）.The relationship between the ratio of BMD（lumbar 1 vertebral body BMD/lumbar 2 vertebral BMD×100%） and the course of fracture were analyzed using one-way analysis of variance.Results There was no significant difference in age,height,and weight among the groups（P〉0.05）.There was significant difference in ratio of BMD among the 4 groups（F=34.839,P〈0.05）.In the multiple comparisons,there was no significant difference between Group A and Group B（P〉0.05）,but the difference between the other two groups was statistically significant（P〈0.05）.Conclusion BMD ratio increases with the duration of the fracture,and BMD of old callus is significantly higher than that of adjacent vertebral body.Under limited conditions,DEXA may be a goodmethod for preoperative positioning of the＂vertebral column＂.