椎体内裂隙征引起的椎体动态不稳与神经功能损伤的关系

Relationship between vertebral instability caused by intravertebral clefts and neurologic injury

背景:目前国内外对于骨质疏松性椎体骨折合并椎体内裂隙征临床症状的细节尚不清楚。目的:分析合并椎体内裂隙征的骨质疏松性骨折患者临床症状与影像学表现的关系。方法:回顾分析168例单节段合并椎体内裂隙征的骨质疏松性骨折患者的临床资料,采用目测类比评分法和Oswestry功能障碍指数进行评估,同时记录迟发性神经功能损害的情况。采用X射线测量局部后凸角、椎体不稳定,通过CT判定椎体后壁骨折,分析合并椎体内裂隙征的骨质疏松性骨折患者临床症状与影像学表现的关系。结果与结论:①在该组患者中,目测类比评分和Oswestry功能障碍指数分别为(7.7±1.6)分和(62.9±19.2)%,存在迟发性神经功能损害的患者有37例(22.0%),椎体局部后凸角与椎体不稳定分别为(16.8±7.7)°和(7.9±4.4)°,椎体后壁骨折的发生率为89.8%。②患者目测类比评分和Oswestry功能障碍指数均与椎体不稳定有显著相关性(r=0.33,P<0.001;r=0.53,P<0.001),但均与椎体局部后凸角呈弱相关性(r=-0.16,P=0.03;r=-0.16,P=0.03)。③存在迟发性神经功能损害的患者椎体不稳定程度明显高于无迟发性神经功能损害的患者(P<0.001),而两者的局部后凸角差异无显著性意义(P=0.18)。所有出现迟发性神经功能损害的患者均存在椎体后壁骨折,但存在椎体后壁骨折的患者大约有2/3表现出迟发性神经功能损害。④结果表明椎体不稳定是导致合并椎体内裂隙征的骨质疏松性骨折患者临床症状的因素之一,椎体不稳定可能是导致迟发性神经功能损害的主要原因。为了有效治疗合并椎体内裂隙征骨质疏松性骨折患者的腰背部疼痛和迟发性神经功能损害,控制合并椎体内裂隙征的骨质疏松性骨折患者的椎体不稳定具有重要意义。

BACKGROUND:The details of clinical symptoms of osteoporotic vertebral fracture with intravertebral clefts are poorly understood at present.OBJECTIVE:To investigate the relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts.METHODS:Clinical data of 168 patients with single-level osteoporotic vertebral fracture with intravertebral clefts were retrospectively analyzed.The clinical symptoms were evaluated by Visual Analogue Scale score and Oswestry Disability Index.The incidence of delayed neurologic deficit was recorded.X-ray was used to measure the local kyphosis angle and vertebral instability,and CT was used to diagnose the posterior wall fracture of the vertebral body.The relationship between clinical symptoms and imaging features of osteoporotic vertebral fracture with intravertebral clefts was analyzed.RESULTS AND CONCLUSION:(1)The Visual Analogue Scale score and Oswestry Disability Index were 7.7±1.6 and(62.9±19.2)%,respectively.Delayed neurologic deficit occurred in 37 patients(22.0%).Local kyphosis angle and vertebral instability was(16.8±7.7)°and(7.9±4.4)°,respectively.The incidence of posterior wall fracture was 89.8%.(2)The Visual Analogue Scale and Oswestry Disability Index were significantly correlated with vertebral instability(r=0.33,P<0.001;r=0.53,P<0.001),but had weak correlation with local kyphosis angle(r=-0.16,P=0.03;r=-0.16,P=0.03).(3)The incidence of vertebral instability in patients with delayed neurologic deficit was significantly higher than that in patients without delayed neurologic deficit(P<0.001),but there was no difference in local kyphosis angle between two groups(P=0.18).All patients with delayed neurologic deficit had posterior wall fracture,but only 2/3 patients with posterior wall fracture had delayed neurologic deficit.(4)In summary,vertebral instability is one of the factors leading to clinical symptoms of osteoporotic vertebral fracture patients with intravertebral clefts.The vertebral instability may be the main cause of delayed neurologic deficit.In order to treat back pain and delayed neurologic deficit effectively,it is important to control vertebral instability of osteoporotic vertebral fracture patients with intravertebral clefts.