核素骨显像在骨质疏松性脊柱骨折诊断中的作用及其临床运用

The role and clinical application of radionuclide bone scan in diagnosis of osteoporotic vertebral fracture

目的探讨核素骨显像在骨质疏松性脊柱新鲜骨折确定的作用及其临床应用价值。方法通过病例对照研究方法对2014年1月—2015年6月陆军军医大学大坪医院脊柱外科收治的骨质疏松性脊柱骨折患者20例24个椎体进行分析,男性7例,女性13例;年龄60~87岁,平均73.2岁。术前常规行查体、脊柱X线片、MRI和全身核素骨显像检查。由2名有经验的脊柱外科医师首先根据查体+脊柱X线片+全身核素骨显像结果对新鲜骨折椎体进行初步定位,然后将定位结果分别与单独使用MRI或全身核素骨显像检查结果进行对比,得出三种检查方法在骨折定位中的准确率。根据最终定位结果对20例患者在局麻下行经皮椎体成形术(PVP),手术前后对患者行VAS评分和X线片检查,评价手术治疗效果。结果术前MRI确定的24个新鲜骨折椎体能被核素骨显像同时确诊和定位,但是另外还有4个椎体出现放射性核素聚集,并且主要定位于L 4、5椎体。查体+脊柱X线片+全身核素骨显像定位准确率100%。术后随访3~6个月,平均4.8个月,X线片示骨折椎体内骨水泥分布良好,患者背部疼痛均显著缓解或消失,手术前后VAS评分差异有统计学意义。结论核素骨显像在脊柱新鲜骨折诊断中有较好的敏感性,但不能完全替代MRI在骨质疏松性脊柱骨折诊断中的定位作用。对于不能行MRI检查的患者,应用核素骨显像定位时一定要紧密结合查体和X线片检查结果进行判断。

Objective To explore the role and clinical value of radionuclide bone imaging in the determination of osteoporotic spinal fresh fracture.Methods A case control study was conducted to analyze 20 cases of osteoporotic spinal fresh fracture treated from Jan.2014 to Jun.2015,including 7 cases of male and 13 cases of female.Patients were aged from 60 to 87 years(average,73.2 years).Preoperative physical examination,spinal radiography,MRI and radionuclide bone scan were performed.Two experienced spinal surgeons firstly conducted preliminary positioning of the vertebral body of fresh fracture according to the results of physical examination+spinal radiography+whole body radionuclide bone scan,and then the localization results with MRI or radionuclide bone scan alone were compared,and the accuracy rate of the three examination methods in fracture localization was obtained.According to the final localization results,percutaneous vertebroplasty was performed in 20 patients under local anesthesia.VAS score and X-ray examination were performed before and after surgery to evaluate the surgical treatment effect.Results All the 24 vertebrae confirmed by MRI as fresh fractures could be confirmed and positioned simultaneously by radionuclide bone scan,while the other 4 vertebrae that were not diagnosed as fresh fractures by MRI were still positive by radionuclide bone scan and were mainly located in the lumbar 4 and 5 vertebral bodies.The accuracy rate of physical examination+spinal radiography+radionuclide bone scan was 100%.Postoperative follow-up was performed for 3-6 months(average,4.8 months),the bone cement distribution in the vertebral body of the fracture was well distributed in the postoperative X-ray examination,the patients back pain was significantly relieved or disappeared,and the difference in VAS score before and after surgery was statistically significant.Conclusion Radionuclide bone scan has good sensitivity in the diagnosis of vertebral fresh fracture,but it can not completely replace the role of MRI in the diagnosis of osteoporosis fracture.For patients who cannot receive MRI,the radionuclide bone scan localization must be closely combined with the results of physical examination and X-ray examination.