俯卧位脊柱全长加压CT检查在骨质疏松性脊柱骨折伴后凸畸形治疗中的作用

Clinical imaging evaluation of osteoporotic spinal fracture with kyphosis by full-spine compression CT in prone position

中文关键词:  影像学检查  局部后凸Cobb角  胸椎后凸Cobb角  腰椎前凸Cobb角  骨质疏松  后凸畸形

英文关键词:Radiological examination  Cobb angle  Thoracic kyphosis  Lumbar lordosis  Osteoporosis  Kyphotic deformity

中文摘要:

  【摘要】 目的：探讨俯卧位脊柱全长加压CT检查在骨质疏松性脊柱骨折伴后凸畸形治疗中的意义。方法：回顾性分析我院2016年4月~2017年4月收治的18例骨质疏松性脊柱骨折伴后凸畸形患者临床资料，其中男1例，女17例，年龄63.5±7.5岁（47~75岁）。患者术前均行俯卧位脊柱全长加压CT检查，术前、术后2周及末次随访时行站立位位脊柱全长X线片检查。影像学测量局部后凸Cobb角（local kyphosis Cobb angle，LKCA）、胸椎后凸角（thoracic kyphosis，TK）和腰椎前凸角（lumbar lordosis，LL）。计算“后凸柔韧度”（站立位LKCA-俯卧位LKCA）/站立位LKCA×100%，根据其指导手术方案。分别比较术前俯卧位加压脊柱全长CT和术前、术后2周及末次随访时站立位脊柱全长X线片测得的LKCA、TK和LL。结果：术前站立侧位X线片所测得的LKCA、TK和LL分别是52.46°±15.63°、36.13°±9.55°和33.31°±10.33°，术前俯卧位脊柱全长加压CT定位像测得的LKCA、TK和LL分别是36.94°±15.69°、28.09°±7.62°和26.99°±6.75°，差异有统计学意义（P<0.05）。后凸柔韧度（31.6±9.89）%（16.4%~60.6%）。术后2周LKCA和TK、LL分别为18.30°±3.57°、18.23°±6.75°和26.99°±6.75°，同末次随访LKCA、TK和LL分别是20.86°±5.34°、17.92°±6.31°和18.54°±4.77°相比，无统计学差异（P>0.05）。术后2周、末次随访时、术前站立位脊柱全长X线片的LKCA、TK、LL同术前俯卧位脊柱全长CT相比有统计学差异（P<0.05）。结论：俯卧位加压脊柱全长CT定位像作为一种全新的新型影像学技术，对骨质疏松性脊柱骨折伴后凸畸形的临床影像学的准确评估和手术方案的制定具有十分重要的指导意义。

英文摘要:

  【Abstract】 Objectives： To investigate the clinical imaging significance of CT in prone position compression spine for osteoporotic spinal fracture with kyphosis. Methods: 18 cases of osteoporotic spinal fracture with kyphosis in our hospital from April 2016 to April 2017 were retrospectively analyzed, including 1 male and 17 females, aged 63.56±7.47(47-75) years old. The imaging evaluation included full length compression CT of spine in prone position and lateral standing X ray films at the preoperation, 2 weeks and final follow-up of postoperation. The local kyphosis Cobb angle(LKCA) of thoracic kyphosis, the thoracic kyphosis and lumbar lordosis were measured. The full-length CT localization images of the spine in the preoperative the prone position was compared with LK, LKCA and LL in the lateral X-ray of standing position at preoperation, 2 weeks after operation and the final follow-up. Results: LKCA, TK and LL of preoperative standing lateral radiograph were 52.46°±15.63°, 36.13°±9.55° and 33.31°±10.33°, respectively. LKCA, TK and LL of preoperative full length CT locating image in prone position were 36.94°±15.69°, 28.09°±7.62° and 26.99°±6.75°, respectively, with significant improvement compared with those in standing lateral X-ray(P<0.05). The average flexible toughness of kyphosis (31.6±7.89)%(16.4%-60.6%). At 2 weeks after operation, LKCA, TK and LL were 18.30°±3.57°, 18.23°±6.75° and 26.99°±6.75°, at the final follow-up, LKCA, TK and LL were 20.86°±5.34°, 17.92°±6.31° and 18.54°±4.77°, which had no significant difference(P>0.05). LKCA, TK and LL in 2 weeks and final follow-up and preoperative standing lateral radiograph were statistically different from those in preoperative full length CT locating image in prone position(P<0.05). Conclusions: Full-length CT localization of pressured spine in prone position is a new imaging technique. It can be used to effectively evaluate the clinical imaging of osteoporotic spinal fracture with kyphosis and thus make surgical plan.