老年人低能量损伤致无压缩骨质疏松性胸腰椎骨折的诊断方法的探索

Exploration of Diagnostic Methods for Uncompressed Osteoporotic Thoracolumbar Fracture in the Elderly Due to Low Energy Injury

目的评估测量和比较胸腰椎矢状位CT重建图像的Hounsfield值是否可作为快速诊断老年无压缩骨质疏松性胸腰椎骨折的方法,为病人得到及时有效的治疗提供参考。方法测量2017—2020年期间胸腰椎骨折住院患者的椎体Hounsfield值,得到靶(中间)椎Hounsfield值和上下锥体Hounsfield值的平均值的差值,以及靶椎体与上下椎体的平均值的差与上下椎体的平均值的比值,并与同时期无胸腰椎骨折老年人相邻椎体Hounsfield值作比较。结果共217例骨折患者的651个椎体入选,137例腰痛无骨折患者的381个椎体作为对照组。ROC曲线显示靶(中间)椎Hounsfield值比上下锥体Hounsfield值的平均值高出25.35或靶(中间)椎体与上下椎体的平均值的差与上下椎体的平均值的比值大于0.2635,可以判断无压缩骨质疏松性椎体骨折,前者具有更佳的敏感度(98.2%)和特异度(98.5%)。结论CT测量靶椎Hounsfield值与上下锥体Hounsfield值平均值的测量和比较可以较好判断老年无压缩骨质疏松性胸腰椎骨折,该方法简单快速,可在临床推广。

Objective To investigate whether the measurement and comparison of Hounsfield units in sagittal CT reconstruction of the thoracolumbar spine can rapidly diagnose osteoporotic fractures in elderly patients with uncompressing osteoporotic fractures and provide a reference for timely and effective treatment.Methods Vertebral Hounsfield units of hospitalized patients with thoracolumbar fracture during 2017-2020 were measured to obtain the difference between the Hounsfield units of the target(middle)vertebral body and the average Hounsfield units of the upper and lower vertebral bodies,and the ratio of the difference between the Hounsfield units of the target vertebral body and the average Hounsfield units of the upper and lower vertebral bodies and the average Hounsfield units of the upper and lower vertebral bodies.The Hounsfield units of adjacent vertebral bodies in the elderly without thoracolumbar fractures were compared.Results 651 vertebrae from 217 patients with fractures were included and 381 vertebrae from 137 patients with low back pain without fractures were used as controls.ROC curve showed that the Hounsfield units of the target(middle)vertebral body were 25.35 higher than the average Hounsfield units of the upper and lower vertebral body,or the ratio of the difference between the Hounsfield units of the target vertebral body and the average Hounsfield units of the upper and lower vertebral bodies and the average Hounsfield units of the upper and lower vertebral bodies was greater than 0.2635,indicating that the osteoporotic vertebral body fracture without compression was existed.The former had better sensitivity(98.2%)and specificity(98.5%).Conclusions CT measurement of Hounsfield units of the target vertebral body and the average Hounsfield units of the upper and lower vertebral body can be used to better judge the uncompressed osteoporotic thoracolumbar fracture in elderly patients.The method is simple and rapid,which can be popularized in clinic.