中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (9): 1883-1889.doi: 10.12307/2025.138

• 骨与关节图像与影像Bone and joint imaging • 上一篇    下一篇

全脊柱MRI评估骨质疏松患者椎体骨折的分布特点及临床意义

周佳俊1，马  飞1，冷叶波1，徐世财1，何宝强1，李  洋1，廖烨晖1，唐  强1，唐  超1，2，王  清1，钟德君1   

  1. 1西南医科大学附属医院骨科，四川省泸州市   646000；2 陆军军医大学新桥医院骨科，重庆市   400030
  • 收稿日期:2024-01-12 接受日期:2024-02-26 出版日期:2025-03-28 发布日期:2024-10-10
  • 通讯作者: 钟德君，博士，主任医师，西南医科大学附属医院骨科，四川省泸州市 646000
  • 作者简介:周佳俊，男，1998年生，四川省盐源县人，汉族，西南医科大学在读硕士，医师，主要从事脊柱外科方面的研究。 马飞，男，1992 年生，四川省成都市人，汉族，西南医科大学毕业，硕士，主治医师，主要从事脊柱外科方面的研究
  • 基金资助:
    四川省医学会资助项目(S17075，Q22008，Q21005)，项目负责人：钟德君；泸州市人民政府与西南医科大学科技战略合作项目(2020LZXNYDJ22)，项目负责人：钟德君；西南医科大学附属医院博士科研启动基金(22155)，项目负责人：钟德君；四川省科技厅自然基金项目(24NSFSC2177)，项目负责人：钟德君

Assessing distribution characteristics and clinical significance of vertebral fractures in patients with osteoporosis based on whole spine MRI

Zhou Jiajun1, Ma Fei1, Leng Yebo1, Xu Shicai1, He Baoqiang1, Li Yang1, Liao Yehui1, Tang Qiang1, Tang Chao1, 2, Wang Qing1, Zhong Dejun1   

  1. 1Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China; 2Department of Orthopedics, Xinqiao Hospital of Army Medical University, Chongqing 400030, China

  • Received:2024-01-12 Accepted:2024-02-26 Online:2025-03-28 Published:2024-10-10
  • Contact: Zhong Dejun, MD, Chief physician, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • About author:Zhou Jiajun, Master candidate, Physician, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China Ma Fei, Master, Attending physician, Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China Zhou Jiajun and Ma Fei contributed equally to this article.
  • Supported by:
    a grant from Sichuan Medical Association, No. S17075, Q22008, Q21005 (to ZDJ); Science and Technology Strategic Cooperation Project between Luzhou Municipal People’s Government and Southwest Medical University, No. 2020LZXNYDJ22 (to ZDJ); Doctoral Research Foundation of Affiliated Hospital of Southwest Medical University, No. 22155 (to ZDJ); Natural Fund Project of Sichuan Science and Technology Department, No. 24NSFSC2177 (to ZDJ) 

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摘要：

文题释义：
骨质疏松性椎体骨折：是骨质疏松患者最常见的并发症，是目前临床上导致中老年人群因腰背部疼痛进行住院治疗的常见疾病之一。脊柱侧位X射线平片上椎体形态测量被认为是筛查骨质疏松骨折的金标准，但既往研究发现，X射线平片的漏诊率较高；此外，X射线平片对新鲜骨折与陈旧骨折、肿瘤及感染的鉴别能力低，因此，一直以来临床医师都在寻找能够提高骨质疏松性椎体骨折诊断率的方法。
全脊柱MRI：虽然进行全脊柱MRI可以准确发现骨折范围，但全脊柱MRI存在临床推广难、经济成本高、花费时间长的问题，且并非所有骨质疏松性椎体骨折患者都需要进行全脊柱MRI，而临床中对于哪些骨质疏松性椎体骨折患者需要进行全脊柱MRI并未达成共识。

摘要
背景：骨质疏松性椎体骨折是骨质疏松患者最常见的并发症。脊柱MRI作为一种新的成像技术，在诊断骨质疏松性椎体骨折方面的灵敏度远高于X射线平片。但全脊柱MRI 费用高，扫描时间长。因此，对于骨质疏松性椎体骨折患者，是否都需要进行全脊柱MRI扫描以及哪些患者需要行全脊柱MRI，目前临床上尚无统一定论。
目的：通过观察骨质疏松性椎体骨折患者的全脊柱MRI影像学资料，分析椎体骨折的分布特点，并探讨其临床意义。
方法：回顾性分析2018年8月至2022年9月在西南医科大学附属医院骨科就诊并被诊断为骨质疏松性椎体骨折患者的病历资料和MRI图像，根据纳入和排除标准将903例患者纳入研究。收集患者一般资料(年龄、性别、体质量指数)、病史特点(病程时间、脊柱外伤手术史、叩击痛区域、疼痛评分等)；通过全脊柱MRI图像分析其椎体骨折特点。首先根据患者椎体骨折数量将患者分为单椎体骨折组(n=484)和多椎体骨折组(n=419)，并分析两组间的差异。然后再根据骨折椎体间的最远间隔数是否≥5将多椎体骨折组再分为2个亚组，其中A组(骨折椎体最远间隔数< 5)306例，B组(骨折椎体最远间隔数≥5)113例，分析2个亚组间的差异。
结果与结论：①903例患者中，骨折椎体≥2个的患者有419例(46.4%)；发生胸腰椎区域骨折的患者有654例(72.4%)，在胸椎区域加腰椎区域和整个胸椎到腰椎区域同时发生骨折的患者有54例(6%)；B组患者中96.5%的患者均存在多区域的叩击痛；②单椎体骨折组和多椎体骨折组相比，两组患者在骨密度、病史时间是否≥1个月、低能量损伤史、查体脊柱轴向叩击痛区域分布及数量比较差异有显著性意义
(P < 0.05)；年龄、性别、体质量指数、是否伴基础疾病、疼痛目测类比评分、是否伴老年胸腰椎骨折史、是否伴胸腰椎手术史与骨折椎体数量无统计学意义(P > 0.05)；③A组与B组进行比较，两组患者骨密度、叩击痛区域分布及数量、低能量损伤病史相比差异有显著性意义(P < 0.05)；两组患者在年龄、性别、是否伴陈旧性骨折病史、目测类比评分、体质量指数、病史时间是否≥1个月、是否伴基础疾病史、是否伴胸腰椎手术史等方面相比差异均无显著性意义 (P > 0.05)；④提示对于有多次低能量创伤史、病史时间大于1个月伴多重叩诊痛、骨密度较低的患者，应警惕多发椎体骨折、跳跃骨折的发生，建议这些患者进行全脊柱MRI检查。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨质疏松椎体骨折, 全脊柱MRI, 骨折特点, 骨密度, 多椎体骨折

Abstract: BACKGROUND: Osteoporotic vertebral fractures are the most common complication in patients with osteoporosis. As a new imaging technique, spine magnetic resonance imaging (MRI) is much more sensitive than X-ray film in the diagnosis of osteoporotic vertebral fractures. However, total spine MRI is costly and takes a long time to scan. Therefore, there is no consensus on whether all patients with osteoporotic vertebral fractures need to undergo total spine MRI scan and which patients need to undergo total spine MRI.
OBJECTIVE: To analyze the distribution characteristics of vertebral fractures and explore their clinical significance by observing the whole spine MRI data of osteoporotic vertebral fractures patients.
METHODS: Data of cases and MRI images of all patients diagnosed with fresh osteoporotic vertebral fractures who visited the Department of Orthopedics, Affiliated Hospital of Southwest Medical University from August 2018 to September 2022 were retrospectively analyzed. 903 patients were included in the study based on inclusion and exclusion criteria. General information (age, gender, and body mass index), medical history characteristics (duration of illness, history of trauma surgery, percussion pain area, and pain score) were collected. The characteristics of vertebral fractures were analyzed through whole spine magnetic resonance imaging. Firstly, based on the number of vertebral fractures in patients, they were divided into the single vertebral fracture group (484 cases) and the multi-vertebral fracture group (419 cases), and the differences were analyzed between the two groups. Then, based on whether the farthest interval between the fractured vertebrae was greater than or equal to 5, the multi vertebral fracture group was further divided into two subgroups. Among them, Group A (the farthest interval between the fractured vertebrae was less than 5) contained 306 cases; Group B (with the farthest interval between fractured vertebral bodies greater than 5) included 113 cases. The differences were analyzed between two subgroups. 
RESULTS AND CONCLUSION: (1) Among 903 patients, 419 patients (46.4%) had more than two fractured vertebrae. There were 654 patients (72.4%) with thoracolumbar fractures, and 54 patients (6%) with fractures in the thoracic plus lumbar region and the entire thoracic to lumbar region. In group B, 96.5% of patients had multiregional percussion pain. (2) Compared with the patients in the single vertebral fracture group and the multi-vertebral fracture group, there were significant differences in bone mineral density, whether the medical history was greater than or equal to 1 month, the history of low energy injury, and the distribution and number of axial percussion pain areas in the spine during physical examination between the two groups (P < 0.05). Age, gender, body mass index, whether there was underlying disease, pain visual analog scale score, whether there was a history of elderly thoracolumbar fracture, and whether there was a history of thoracolumbar surgery, and the number of fractured vertebrae had no statistical significance (P > 0.05). (3) There were statistically significant differences between the Groups A and B in bone mineral density, the distribution and quantity of percussion pain area, and the history of low energy injury 
(P < 0.05). There were no significant differences in age, gender, history of old fractures, visual analog scale score, body mass index, whether the medical history was longer than or equal to 1 month, history of underlying diseases, and history of thoracolumbar surgery between the two groups (P > 0.05). (4) Patients with multiple low-energy trauma history, history of more than 1 month, multiple percussion pain, and the lower bone mineral density should be alert to the occurrence of multiple vertebral fracture and jump fracture. We recommend the whole spinal MRI for these patients. 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: osteoporotic vertebral fracture, whole spine MRI, fracture characteristics, bone mineral density, multi-vertebral fractures

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