骨质疏松性腰椎压缩骨折患者椎旁肌定量CT参数与椎体压缩程度及术后并发症的关系

Associations of quantitative CT parameters of lumbar paraspinal muscles with fracture severity and postoperative complications in patients with osteoporotic vertebral compression fractures

中文关键词:  骨质疏松性椎体压缩骨折  椎体压缩程度  并发症  腰椎旁肌  定量CT参数  相关性

英文关键词:Osteoporotic vertebral compression fractures  Vertebral compression degree  Complications  Lumbar paraspinal muscles  Quantitative CT parameters  Correlation

中文摘要:

  【摘要】 目的：探讨骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures，OVCF）患者腰椎旁肌定量CT参数与椎体压缩程度及术后并发症的关系。方法：回顾性分析2022年6月~2024年12月我院收治的222例OVCF患者，其中男性41例，女性181例；年龄68~78岁（73.1±2.6岁），所有患者均行椎体后凸成形术治疗。依据Genant半定量分级法，将伤椎按照椎体压缩率<25%、25%~40%及>40%分别划分为轻度组（80例）、中度组（82例）及重度组（60例）。收集椎旁肌（椎旁后肌及腰大肌）定量CT参数：肌间脂肪组织横截面积（cross-sectional area of intermuscular adipose tissue，CSAIMAT）、肌间脂肪浸润率（intermuscular adipose tissue，IMAT）及CT值。收集患者的临床资料，包括年龄、性别、体重指数、高血压病、糖尿病、高脂血症、慢性肾脏病、骨折新鲜度、饮酒史、吸烟史及术前骨密度、骨折严重程度、住院时间、手术时间等资料。采用Pearson相关分析评估CT定量参数与椎体压缩率的相关性。根据术后6个月内是否发生并发症，将患者分为发生组（62例）和未发生组（160例），采用单因素分析两组患者基线资料和腰椎旁肌定量CT参数，多因素logistic回归分析术后并发症影响因素。以术后并发症发生情况作为结局变量，以椎旁后肌与腰大肌的CT定量指标作为检测变量，构建受试者工作特征（receiver operating characteristic，ROC）曲线，评估各指标对术后并发症发生的预测能力。结果：不同椎体压缩程度OVCF患者椎旁后肌及腰大肌CSAIMAT、IMAT及CT值均有统计学差异（P<0.001）；余CT定量指标无统计学差异（P>0.05）。重度组CSAIMAT、IMAT均显著性高于中度组和轻度组，CT值显著性低于中度组和轻度组（P<0.01）；中度组CSAIMAT显著性高于轻度组，CT值显著性低于轻度组（P<0.01）。术后6个月随访期间，62例患者发生并发症75例次，包括18例骨水泥渗漏、6例再次骨折、12例感染、19例神经压迫症状和20例围术期血红蛋白下降。单因素分析结果显示，两组患者年龄、性别、体重指数、高血压、糖尿病、高脂血症、慢性肾脏病、吸烟史、饮酒史、骨折新鲜度、骨密度、住院时间及手术时间均无统计学差异（P>0.05）；椎体压缩程度、椎旁后肌CSAIMAT、IMAT、CT值及腰大肌CSAIMAT、IMAT比较差异均有统计学意义（P<0.05）。多因素logistic回归分析结果显示，椎旁后肌CSAIMAT、IMAT及腰大肌CSAIMAT、IMAT升高均与术后并发症发生风险增加相关，而椎旁后肌CT值升高与术后并发症发生风险降低相关（P<0.05）。基于椎旁后肌和腰大肌CSAIMAT、IMAT及椎旁后肌CT值建立的logistic回归模型在预测OVCF患者术后并发症发生中的AUC为0.993（95%CI：0.959～1.000），敏感度为95.16%，特异度为96.09%，其预测效能优于各单一CT定量指标（DeLong检验，P<0.05）。结论：不同椎体压缩程度OVCF患者椎旁后肌及腰大肌CT定量参数存在显著差异，并与术后并发症发生相关；CSAIMAT、IMAT及CT值等CT定量指标可作为术后并发症风险评估的客观影像学指标。

英文摘要:

  【Abstract】 Objectives: To investigate the associations between quantitative CT parameters of the lumbar paraspinal muscles, fracture severity, and postoperative complications in patients with osteoporotic vertebral compression fractures(OVCF). Methods: A total of 222 patients with OVCF who underwent percutaneous kyphoplasty(PKP) at our hospital between June 2022 and December 2024 were retrospectively enrolled, including 41 males and 181 females, aged 68-78 years(73.1±2.6 years). According to the Genant semiquantitative grading system, patients were classified into a mild group(n=80, vertebral compression ratio <25%), moderate group(n=82, vertebral compression ratio 25%-40%), and severe group(n=60, vertebral compression ratio >40%). Quantitative CT parameters of the paraspinal muscles and psoas major muscles were measured, including the cross-sectional area of intermuscular adipose tissue(CSAIMAT), intermuscular adipose tissue(IMAT) infiltration, and CT attenuation values. Demographic and clinical characteristics, including age, sex, body mass index(BMI), hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, fracture freshness, smoking history, alcohol consumption, preoperative bone mineral density, fracture severity, length of hospital stay, and operative time, were collected. Pearson correlation analysis was performed to evaluate the correlations between quantitative CT parameters and vertebral compression ratio. According to the occurrence of postoperative complications within 6 months after surgery, patients were divided into a complication group(n=62) and a non-complication group(n=160). Univariate analysis was performed to compare baseline characteristics and quantitative CT parameters between the two groups, followed by multivariate logistic regression analysis to identify CT parameters associated with postoperative complications. Receiver operating characteristic(ROC) curves were constructed using the occurrence of postoperative complications as the outcome variables, and CT quantitative indicators of the paraspinal muscle and psoas major muscle as the detection variables to evaluate the predictive ability of each index for the occurrence of postoperative complications. Results: Significant differences were observed in the CSAIMAT, IMAT, and CT attenuation values of the paraspinal muscles and psoas major muscles among patients with different vertebral compression degree groups(P<0.001), whereas no significant differences were found in the remaining quantitative CT parameters(P>0.05). Pairwise comparisons demonstrated that the severe group had significantly higher CSAIMAT and IMAT values and lower CT attenuation values than both the moderate and mild groups(P<0.01). Compared with the mild group, the moderate group exhibited significantly higher CSAIMAT values and lower CT attenuation values(P<0.01). During the 6-month follow-up, postoperative complications occurred in 62 patients, including bone cement leakage(18 cases), recurrence of vertebral fracture(6 cases), infection(12 cases), neurological compression symptoms(19 cases), and perioperative hemoglobin reduction(20 cases). Univariate analysis showed no significant differences between the two groups with respect to age, sex, BMI, hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, smoking history, alcohol consumption, fracture freshness, bone mineral density, length of hospital stay, or operative time(P>0.05). However, significant differences were observed in vertebral compression degree, CSAIMAT, IMAT, and CT attenuation values of the paraspinal muscles, as well as CSAIMAT and IMAT of the psoas major muscles(P<0.05). Multivariate logistic regression analysis demonstrated that increased CSAIMAT and IMAT of both the paraspinal muscles and psoas major muscles were associated with an increased risk of postoperative complications, whereas higher CT attenuation values of the paraspinal muscles were associated with a reduced risk of postoperative complications(P<0.05). The logistic regression model incorporating CSAIMAT and IMAT of the paraspinal muscles and psoas major muscles, together with the CT attenuation values of the paraspinal muscles, achieved an area under the ROC curve(AUC) of 0.993[95% confidence interval(CI): 0.959-1.000], with a sensitivity of 95.16% and a specificity of 96.09%. Its predictive performance was significantly superior to that of any individual quantitative CT parameter(DeLong test, P<0.05). Conclusions: Quantitative CT parameters of the paraspinal muscles and psoas major muscles differ significantly among OVCF patients with vertebral compression degrees and are associated with postoperative complications. Quantitative CT parameters, including CSAIMAT, IMAT, and CT attenuation values, may serve as objective imaging biomarkers for assessing the risk of postoperative complications.