^(99)Tc^(m)-MDP全身骨显像对老年性骨质疏松症患者新鲜骨质疏松性椎体压缩性骨折的筛查价值

Value of ^(99)Tc^(m)-MDP whole-body bone scan in screening fresh osteoporotic vertebral compression fractures in geriatric patients with osteoporosis

目的:探讨^(99)Tc^(m)-亚甲基二膦酸盐(MDP)全身骨显像在老年性骨质疏松症(OP)患者发生急慢性腰背部疼痛时对新鲜骨质疏松性椎体压缩性骨折(OVCF)的筛查价值。方法:回顾性分析2017年1月至2019年12月于厦门大学附属中山医院因急慢性腰背部疼痛行^(99)Tc^(m)-MDP全身骨显像的104例老年性OP患者的临床资料和其他影像学资料,其中男性33例、女性71例,年龄62~88(78.8±7.7)岁。将患者根据年龄分为60~69岁组(42例)、70~79岁组(43例)和≥80岁组(19例);根据疼痛发作时间分为急性疼痛组(78例)和慢性疼痛组(26例)。参考X射线检查结果,分析所有患者的^(99)Tc^(m)-MDP全身骨显像图像,计算其对新鲜OVCF的检出率。组间比较采用χ^(2)检验。结果:^(99)Tc^(m)-MDP全身骨显像对104例老年性OP患者新鲜OVCF的检出率为72.1%(75/104),急性疼痛组患者新鲜OVCF的检出率高于慢性疼痛组[87.2%(68/78)对26.9%(7/26),χ^(2)=35.209,P<0.001],60~69岁组、70~79岁组、≥80岁组患者新鲜OVCF的检出率分别为66.7%(28/42)、76.7%(33/43)、73.7%(14/19),差异无统计学意义(χ^(2)=1.101,P>0.05)。在3个年龄组患者中,发生急性疼痛的患者新鲜OVCF的检出率均高于发生慢性疼痛的患者[83.9%(26/31)对18.2%(2/11)、88.6%(31/35)对25.0%(2/8)、91.7%(11/12)对42.9%(3/7),χ^(2)=12.948、11.398、5.456,均P<0.05]。已检出的新鲜OVCF中累及单个椎体的患者占80.0%(60/75),累及2个及2个以上椎体的患者占20.0%(15/75)。结论:^(99)Tc^(m)-MDP全身骨显像在老年性OP患者发生腰背部疼痛(特别是急性腰背部疼痛)时对新鲜OVCF具有临床筛查价值。

Objective To investigate the value of ^(99)Tc^(m)-methylenediphosphonate(MDP)whole-body bone scan in screening fresh osteoporotic vertebral compression fractures(OVCF)in geriatric patients with osteoporosis(OP)and acute or chronic low back pain.Methods The clinical data and other imaging data of 104 geriatric patients with OP who underwent ^(99)Tc^(m)-MDP whole-body bone scan for acute or chronic low back pain in Zhongshan Hospital Xiamen University from January 2017 to December 2019 were analyzed retrospectively.The patients included 33 males and 71 females aged 62-88(78.8±7.7)years old.The patients were divided into 60-69 years old group(n=42),70-79 years old group(n=43),and≥80 years old group(n=19)according to their age and were divided into acute pain group(n=78)and chronic pain group(n=26)according to the pain onset time.With reference to X-ray examination results,the ^(99)Tc^(m)-MDP whole-body bone scan images of all patients were analyzed,and the detection rates of fresh OVCF were calculated.χ^(2) test was used for comparison among groups.Results The detection rate of fresh OVCF in 104 geriatric patients with OP by ^(99)Tc^(m)-MDP whole-body bone scan was 72.1%(75/104),and the detection rate of fresh OVCF in the acute pain group was higher than that in the chronic pain group(87.2%(68/78)vs.26.9%(7/26),χ^(2)=35.209,P<0.001).The detection rates of fresh OVCF in the three age groups were 66.7%(28/42),76.7%(33/43),and 73.7%(14/19),respectively,and the difference was not statistically significant(χ^(2)=1.101,P>0.05).Among the three age groups,the detection rates of fresh OVCF in patients with acute pain was higher than that in patients with chronic pain(83.9%(26/31)vs.18.2%(2/11),88.6%(31/35)vs.25.0%(2/8),91.7%(11/12)vs.42.9%(3/7);χ^(2)=12.948,11.398,5.456;all P<0.05).Among the fresh OVCF detected,80.0%(60/75)involved a single vertebral body,and 20.0%(15/75)involved two or more vertebral bodies.Conclusion ^(99)Tc^(m)-MDP whole-body bone scan has clinical screening value for fresh OVCF when low back pain(especially acute low back pain)occurs in geriatric patients with OP.