摘要目的 探讨胸腰段骨质疏松压缩性骨折中伤椎的CT值压缩比(CT value compression ratio，CTCR)对椎间盘损伤的诊断价值。方法 回顾性分析我院2018年1月至2020年1月胸腰段骨质疏松压缩性骨折的91例患者资料，分析利用伤椎CTCR及伤椎丢失高度(loss of vertebral body height，LOVBH)诊断椎间盘损伤的准确性，同时分析其他CT征象如局部后凸角(local kyphosis，LK)、棘突间距增宽(interspinouswidening，ISW)、椎体平移(vertebral translation，VBT)、后方结构骨折(posterior structures fracture，PSF)与椎间盘损伤的相关性。结果 椎间盘损伤组CTCR显著高于椎间盘完整组(P＜0.001)，但LOVBH比较，两组间差异无统计学意义(P＝0.085)。其他CT征象中仅VBT两组间比较差异有统计学意义(P＝0.043)。逻辑回归显示，CTCR(OR：4.686，95%CI：1.810~12.133，P＝0.001)与椎间盘损伤相关，受试者工作特征曲线(receiver operating characteristic，ROC)显示CTCR诊断椎间盘损伤的曲线下面积(area under curve，AUC)为0.750(P＜0.001)，截断值为1.775(敏感度：67.4%，特异度：77.8%)。结论 在胸腰段脊柱骨质疏松压缩性骨折的患者中，利用伤椎CTCR诊断椎间盘损伤较为可靠，鉴于CT检查在临床应用的普遍性，伤椎CTCR可较为便捷地为临床医师提供椎间盘损伤的信息。
Abstract：Objective To investigate the value of CT value compression ratio (CTCR) in the diagnosis of disc injury in thoracolumbar osteoporotic compression fractures. Methods A total of 91 patients with thoracolumbar compression fractures from January 2018 to January 2020 were analyzed retrospectively.The diagnostic accuracy of CTCR and loss of vertebral body height(LOVBH) in disc injury was analyzed.The correlation of other CT signs and disc injury were also analyzed. Results The CTCR of the disc injured group was significantly higher(P＜0.001) than that of the disc intact group，but the LOVBH between the two groups showed no significant difference (P＝0.085).In other CT signs，only VBT showed significant difference(P＝0.043) between the two groups.Logistic regression showed that CTCR (OR：4.686，95% CI：1.810~12.133，P＝0.001) was related to disc injury.ROC curve showed that the area under curve (AUC) of CTCR in diagnosing disc injury was 0.750 (P＜0.001)，and the cut-off value was 1.775 (sensitivity：67.4%，specificity：77.8%).Conclusion In the patients with thoracolumbar osteoporotic compression fractures，it is more reliable to use the injured vertebra CTCR to diagnose the disc injury.In view of the universality of CT examination in clinical application，the injured vertebra CTCR can provide the clinicians with the information of disc injury more conveniently.
刘冬，仲丹，胡英良，曹爱红 *. 伤椎CT值压缩比对骨质疏松压缩性骨折椎间盘损伤的诊断价值[J]. 实用骨科杂志, 2020, 26(10): 865-868.
Liu Dong，Zhong Dan，Hu Yingliang，et al. CT Value Compression Ratio in the Diagnosis of Disc Injury in Osteoporotic Compression Fractures. sygkzz, 2020, 26(10): 865-868.
［1］O Johnell，JA Kanis.An estimate of the worldwide prevalence and disability associated with osteoporotic fractures［J］.Osteoporos Int，2006，17(12)：1726-1733.
［2］印平，马远征，马迅，等.骨质疏松性椎体压缩性骨折的治疗指南［J］.中国骨质疏松杂志，2015，21(6)：643-648.
［3］Martiniani M，Vanacore F，Meco L，et al.Is posterior fixation alone effective to prevent the late kyphosis after TL fracture?［J］.Eur Spine J，2013，22(Suppl 6)：951-956.
［4］Sander AL，Laurer H，Lehnert T，et al.A clinically usefuIclassificationof traumatic intervertebral disk lesions［J］.AJR Am J Roentgenol，2013，200(3)：618-623.
［5］宋超，林斌，陈志达，等.胸腰椎骨折合并椎间盘损伤的研究进展［J］.中国脊柱脊髓杂志，2019，29(10)：932-935.
［6］Yeol LK，Minwoo K，Yun SS，et al.The relationship between superior disc-endplate complex injury and correction loss in young adult patients with thoracolumbar stable burst fracture［J］.Clin Orthop Surg，2017，9(4)：465-471.
［7］Zou D，Li W，Deng C，et al.The use of CT hounsfield unit values to identify the undiagnosed spinal osteoporosis in patients with lumbar degenerative diseases［J］.Eur Spine J，2019，28(8)：1758-1766.
［8］Batawil N，Sabiq S.Hounsfield unit for the diagnosis of bone mineral density disease：a proof of concept study［J］.Radiography，2016，22(2)：e93-e98.
［9］邹达，李危石，陈仲强，等.椎体CT值在腰椎短节段内固定术后螺钉松动预测中的应用［J］.中国脊柱脊髓杂志，2018，28(5)：447-455.
［10］魏晓东，宋宏亮，龚维明，等.椎间盘损伤的胸腰椎骨折患者修复后易出现严重后凸畸形［J］.中国组织工程研究，2016，20(17)：51-57.
［11］Oner FC，Vander rijt RR，Ramos Lm，et al.Changesin the disc space after fractures of the thoracolumbarspine［J］.J Bone Joint Surg(Br)，1998，80(5)：833-839.
［12］Grados F，Roux C，Vernejoul MCD，et al.Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures［J］.OsteoporosInt，2001，12(9)：716-722.
［13］Song LJ，Wang LL，Ning L，et al.A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese［J］.OsteoporosInt，2018，29(11)：2495-2504.
［14］Hong JY，Choi SW，Kim GD，et al.Reliability analyses of radiographic measures of vertebral body height loss in thoracolumbar burst fractures［J］.World Neurosurg，2019(129)：e191-e198.
［15］Mi J，Sun XJ，Zhang K，et al.Prediction of MRI findings including disc injury and posteriorligamentous complex injury in neurologically intact thoracolumbarburst fractures by the parameters of vertebral body damage on CT scan［J］.Injury，2018，49(2)：272-278.
晋公网安备 14010702070875号