骨质疏松椎体压缩性骨折MRI STIR黑色线信号与PVP疗效的相关性

Correlation between MRI STIR black line signal and clinical outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fracture

[目的]探讨胸腰椎骨质疏松压缩性骨折MRI STIR黑色线信号与PVP术后疗效的相关性.[方法]2014年5月~2016年1月来本院就诊并接受PVP手术治疗的单椎体骨质疏松压缩性骨折患者482例,根据MRISTIR上是否出现黑色线信号187例列入阳性组,295例列入阴性组.比较两组围手术期资料、VAS评分和JOA评分、伤椎高度比和局部Cobb角变化,以及末期随访时再发骨折、椎体高度丢失和Cobb角变化及发生率.[结果]两组患者年龄、性别构成、累及节段构成和骨密度值的差异均无统计学意义(P>0.05).所有患者均顺利完成手术,两组在骨水泥注射量、骨水泥渗漏发生率的差异无统计学意义(P>0.05),但阴性组骨水泥弥散度优于阳性组,差异有统计学意义(P<0.05).两组患者的VAS评分随时间延长而显著减少(P<0.05),而JOA评分则随时间延长显著增加(P<0.05);但是,相应时间点两组间VAS和JOA评分的差异均无统计学意义(P>0.05).末次随访时,阳性组再骨折发生率显著高于阴性组[(25/162) vs (23/272),P<0.05)],阳性组椎体高度丢失发生率显著高于阴性组[(43/144) vs (23/272),P<0.05],阳性组Cobb角增加的发生率显著高于阴性组[(25/162) vs (42/253),P<0.05].[结论] PVP手术是治疗胸腰椎骨质疏松压缩性骨折的重要有效手段,椎体骨质疏松压缩性骨折MRI STIR黑色线信号对PVP术后疗效具有一定预判性,术中应充分把握骨水泥弥散情况,提高术后疗效,减少丢失率.

[Objective] To explore the correlation between MRI STIR black line signal and clinical outcomes of percutaneous vertebroplasty(PVP) for thoracolumbar vertebral osteoporotic compression fractures. [Methods] A retrospective study was done on a total of 482 patients who underwent PVP for single-segment osteoporotic vertebral compression fractures in our hospital from May 2014 to January 2016. Based on whether or not black line signal found on MRI STIR, 187 patients were enrolled into the positive group, while 295 patients fell into the negative group. The perioperative data, VAS and JOA score, radiographic measurements including height ratio and local Cobb angle, as well as incidences of refracture, vertebral height loss and Cobb angle variation at the latest follow-up were compared between the two groups. [Results] There were no significant differences between the two groups in age, gender, location involved and bone mineral density(P>0.05). All patients had operation performed successfully. Although no statistically significant differences were proved in volume of bone cement injected and the incidence of cement leakage between them(P>0.05), the distribution of cement in the positive group was significantly superior to the negative group(P<0.05). The VAS significantly decreased, while the JOA scores significantly increased over time in both group(P<0.05), nevertheless no significant differences in the two parameters were found between the two groups at any corresponding time point(P>0.05). At the latest follow up, the incidences of refracture [(25/162) versus(23/272), P<0.05] vertebral height loss [(43/144) versus(23/272), <0.05], and Cobb angle variation [(25/162) versus(42/253), P<0.05]proved significant greater in the positive group than the negative group. [Conclusions] The patients with MRI STIR black line signal is relatively prone to refracture and correction loss after PVP for osteoporotic compression thoracolumbar fractures. Therefore, this sign might be significant for evaluation of PVP prognosis.