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CT平扫+三维重建技 术在观察骨质疏松 性椎体压缩骨折患 者椎弓根宽度变化 中的应用*

作者:潘海英 妥渊茹 李 霞 上展增

所属单位:武警青海总队医院影像科(青海 西宁 810000)

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摘要

目的 探讨CT平扫+三维重建技 术对骨质疏松性椎体压缩骨折患者椎弓 根宽度变化的评估作用。方法 收集我院 骨科2013年4月至2016年4月所收治的骨折 患者资料进行回顾性分析。骨质疏松性 椎体压缩骨折患者(n=58)纳入A组,胸腰 椎骨折患者(n=46)纳入B组。比较脊椎两 侧POW值及A组与B组脊椎POW值,计算A组 与B组患者的椎弓根细小发生率。结果 58 例患者脊椎两侧POW测量值的差异均无统 计学意义(P>0.05)。A组T11-L3的POW均高 于B组,差异有统计学意义(P﹤0.05)。L4 与L5的POW与B组之间则无统计学意义(P> 0.05)。结论 应用CT平扫+三维重建技术 对骨质疏松性椎体压缩骨折患者进行检查 可有效测量患者椎弓根宽度,从而评估患 者经皮椎体成形术穿刺及椎弓根置钉的可 行性,为手术提供指导。

Objective To explore evaluation function of CT scan and three-dimensional reconstruction technique in the changes of width of pedicle in patients with osteoporotic vertebral compression fractures. Methods A retrospective analysis of clinical data was carried out in fracture patients treated in department of orthopedics of our hospital from April 2013 to April 2016. Patients with osteoporotic vertebral compression fractures (n=58) were divided into group A, patients with thoracolumbar fracture were divided into group B (n=46). POW value in two sides of vertebrae, POW value in vertebrae in group A and group B were compared, incidence of tiny vertebral pedicle in group A and group B were calculated. Results There was no significant difference in POW measured value in two sides of vertebrae in 58 patients (P>0.05). POW in T11-L3 in group A were significantly higher than group B (P<0.05). There was no significant difference in POW in L4 and L5 compared with group B (P>0.05). Conclusion Application of CT scan and threedimensional reconstruction technique can measure patients' width of pedicle effectively in patients with osteoporotic vertebral compression fractures, thus evaluating feasibility of percutaneous vertebroplasty and pedicle for screw placement, and provide direction for operation.

【关键词】骨质疏松性椎体压缩;椎弓根 宽度;CT;三维重建

【中图分类号】R445.3;R683

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.11.036

前言

骨质疏松症为所因素所致全身代谢性疾病,患者骨量减少、骨脆 性升高,其最大危害在于增加骨折风险,其中以骨质疏松性椎体压缩 骨折较常见。该骨折发病人群以女性居多,50岁以上女性中发病率约 为26%,80岁以上女性中则达40%[1],多发于L1、L2及下胸椎。骨质疏 松性椎体压缩骨折易引起腰背部疼痛、脊柱后凸畸形,严重者并发呼 吸与消化系统功能障碍,使患者生活质量受到较大影响。骨质疏松性 椎体压缩骨折的保守治疗不仅无法有效缓解疼痛症状,且长期卧床还 会导致骨量进一步丢失,引发多系统并发症,导致基础内科疾病的加 重,因而目前临床多以外科手术治疗为主[2-3],包括经皮椎体成形术、 经皮椎体后凸成形术、椎体强化术等,均取得良好疗效。但以上外科 手术的进行都需经椎弓根进行操作,而椎弓根连接脊柱前后柱,为脊 柱外科手术重要通路。对比我院收治骨质疏松性椎体压缩骨折患者及 胸腰椎骨折患者的椎弓根宽度,观察骨质疏松性椎体压缩骨折患者的 椎弓根宽度变化情况,现报道如下。