基于CT有限元分析预测椎体撞击骨折的研究

Research on Predicting Vertebral Impact Fractures Based on CT Finite Element Analysis

目的本研究旨在通过基于CT定量有限元分析(finite element analysis,FEA)来确定椎体强度与椎体骨折(vertebral fracture,VF)、骨密度(bone mineral density,BMD)之间的关系,以期为临床诊治提供参考。方法回顾性分析本院于2020年1月至2020年12月期间收治的26例椎体骨折患者和62例匹配的对照组。腰椎CT扫描评估椎体压缩强度、积分vBMD、骨小梁vBMD、基于CT的BMC和基于CT的aBMD。结果调整年龄、BMI和椎体骨折状态后,基线时脊柱强度较低与新发或恶化的椎体骨折风险增加相关(OR=5.2,95%CI:1.3-19.8)。ROC曲线下面积显示,椎体强度比基于CT的aBMD更好地预测椎体骨折的发生(AUC=0.804比0.715,P=0.05),但不如积分vBMD(AUC=0.815)或基于CT的BMC(AUC=0.794)。此外,脆性骨强度阈值在识别椎体骨折方面倾向于比骨密度分类的骨质疏松症有更好的敏感性(0.46 vs.0.23,P=0.09)。结论椎体强度测量与椎体骨折事件之间存在关联,基于CT的有限元分析估计的骨强度提供了同等或更好的预测椎体骨折事件的能力,基于CT的有限元分析估计椎体强度对于识别脊柱骨折的高危患者是有用的。

Objective This study aims to determine the relationship between vertebral strength,vertebral fracture(VF),and bone mineral density(BMD)based on CT quantitative finite element analysis(FEA),in order to provide reference for clinical diagnosis and treatment.Methods A retrospective analysis was conducted on 26 patients with vertebral fractures and 62 matched control groups admitted to our hospital from January 2020 to December 2020.Lumbar CT scanning evaluates vertebral compression strength,integral vBMD,trabecular vBMD,CT based BMC,and CT based aBMD.Results After adjusting for age,BMI,and vertebral fracture status,lower baseline spinal strength was associated with an increased risk of new or worsening vertebral fractures(OR=5.2,95%CI:1.3-19.8).The area under the ROC curve shows that vertebral body strength is better than CT based aBMD in predicting the occurrence of vertebral fractures(AUC=0.804 vs 0.715,P=0.05),but not as good as integrating vBMD(AUC=0.815)or CT based BMC(AUC=0.794).In addition,the brittle bone strength threshold tends to have better sensitivity in identifying vertebral fractures compared to osteoporosis classified by bone density(0.46 vs.0.23,P=0.09).Conclusion There is a correlation between vertebral body strength measurement and vertebral fracture events.Bone strength estimation based on CT finite element analysis provides equal or better predictive ability for vertebral fracture events.Estimation of vertebral body strength based on CT finite element analysis is useful for identifying high-risk patients with spinal fractures.