QCT与三维CT在绝经期OP椎体骨折患者中的应用价值分析

Application value analysis of QCT and three-dimensional CT in menopause patients with OP vertebral fracture

目的探究定量CT(quantitative computed tomography,QCT)与三维CT在绝经期骨质疏松(osteoporosis,OP)性椎体骨折患者中的应用价值。方法选取2019年4月至2020年9月临海市第一人医院收治的OP椎体骨折的85例绝经期患者作为OP骨折组,同时选取性别、年龄均与OP骨折组相对应的健康志愿者40例作为健康对照组,分析两组患者的骨密度CT值和T值,以术后病理为“金标准”,通过QCT检查、三维CT检查及联合检查,对前柱骨折、中柱骨折、后柱骨折、稳定性骨折、爆裂骨折、椎管狭窄检查准确率进行比较,分析不同检查方式的特异性、敏感度、阳性预测值及阴性预测值。结果与健康对照组相比,OP骨折组骨密度T值、CT值、总脂肪面积、截面观察点均降低,腹内脂肪面积、骨骼肌面积、局部后凸角、椎体楔变角水平均升高,差异均有统计学意义(P<0.05);QCT检查、三维CT检查的医师评分、前柱骨折、中柱骨折及后柱骨折、稳定性骨折、爆裂骨折及椎管狭窄检查准确率均低于联合检查,差异均有统计学意义(P<0.05);QCT检查和三维CT检查的敏感度、特异性、阳性预测值及阴性预测值均低于联合检查(P<0.05)。结论QCT与三维CT均可应用于绝经期OP椎体骨折患者检查,通过QCT联合三维CT对患者检查,具有较高敏感度和特异性,能够为绝经期OP椎体骨折患者后续的治疗提供重要的指导价值。

Objective To explore the quantitative computed tomography CT(QCT)and three-dimensional(3D)CT in the treatment of postmenopausal osteoporosis(OP)patients with vertebral fractures.Methods Eighty-five menopausal patients with OP vertebral fractures admitted to Linhai First People’s Hospital from April 2019 to September 2020 were selected as the OP fracture group,and another 40 healthy volunteers with gender and age corresponding to the OP fracture group were selected as the healthy control group.Bone density CT values and T values of the two groups were analyzed,and postoperative pathology was used as the“gold standard”.Through QCT examination,3D CT examination and joint examination,the accuracy of anterior column fracture,middle column fracture,posterior column fracture,stability fracture,burst fracture and spinal stenosis were compared,and the specificity,sensitivity,positive predictive value and negative predictive value of different examination methods were analyzed.Results Compared with the healthy control group,the OP fracture group had lower BMD T values,CT values,total fat area(TFA)and section observation point(R),and higher levels of abdominal fat area(SFA),skeletal muscle area(SMA),local kyphosis angle(LK)and vertebral wedge variable angle(SIEA),all with statistically significant differences(P<0.05).The accuracy of physician’s score,anterior column fracture,middle column fracture and posterior column fracture,stability fracture,burst fracture and spinal stenosis detection were lower for QCT examination and 3D CT examination than for combined examination,all with statistically significant differences(P<0.05).The sensitivity,specificity,positive predictive value and negative predictive value of the combined examination were higher than those of QCT examination and 3D CT examination(P<0.05).Conclusion QCT and 3D CT can be applied in the examination of menopausal OP vertebral fracture patients.QCT combined with 3D CT can provide important guidance value for the follow-up treatment of menopausal OP vertebral fracture patients,with high sensitivity and specificity,and help the recovery of patients.