骨质疏松性胸腰椎骨折MRI STIR黑色线性信号与外力程度的关系

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文章编号:2095-4344(2020)09-01400-05
ZHONG YM, LUO M, TANG FB, TANG C. Relationship between a linear black signal area of STIR image in MRI of osteoporotic thoracolumbar fracture and the size of external force. Zhongguo Zuzhi Gongcheng Yanjiu. 2020;24(9):1400-1404. DOI:10.3969/j.issn.2095-4344.2512
(2) 根 据 创 伤 程 度 设 计 分 组。
分组：
(1)无明显外力作用组； (2)低能量外力作用组； (3)高能量外力作用组。
方法：
(1)统计 3 组总例数； (2)记录 MRI STIR 有
黑色线性信号椎体
例数及所在部位。
Hale Waihona Puke Baidu
钟远鸣，男，1965 年生， 广西壮族自治区南宁市 人，壮族，广西中医药大 学毕业，硕士，博士生导 师，主任医师，主要从事 脊柱脊髓相关疾病诊治研 究。
文题释义： MRI STIR 椎体内黑色线性信号：指的是在 MRI T2 压脂像中，骨折椎体内会出现高信号，在骨折椎体高信 号中有线性低信号出现，且在椎体内，为椎体压缩性骨折的特殊表现，出现骨折椎体内黑色线性信号往往提 示着骨折保守治疗不愈合。
摘要 背景：随着社会老龄化加重，骨质疏松椎体骨折患者日益增多，主要表现为胸腰椎体压缩性骨折，严重影响 老年人的日常生活。因此，研究外力程度与骨质疏松胸腰椎体骨折在影像 MRI STIR 上表现的关系，可以更 好的为临床诊疗提供依据。 目的：探讨外力作用程度与骨质疏松性胸腰椎骨折 MRI STIR 黑色线性信号的相关性。 方法：回顾性分析 2013 年 9 月至 2016 年 9 月在广西中医药大学第一附属医院脊柱外科住院，明确诊断为 骨质疏松性胸腰椎骨折的患者，3 组中所有病例均行定量 CT 检查确诊为骨质疏松(骨密度值≤80 mg/cm3)。 所有患者对治疗方案均知情同意，且得到医院伦理委员会批准。根据创伤史，分为无明显外力作用组(无明 显诱因、无外力作用等)、低能量外力作用组(扭伤、弯腰提重物、扛重物等)、高能量外力作用组(平路摔倒 臀部着地、跌倒、撞伤等)，统计各组间性别、年龄、骨折部位(胸腰段和非胸腰段)、MRI STIR 黑色线性信 号椎体例数及所在的部位(胸腰段和非胸腰段)。3 组间年龄属于计量资料采用方差分析；性别、骨折部位、 MRI STIR 黑色线性信号的椎体数量及所在部位属于计数资料，用 Pearsonχ2 检验。 结果与结论：①纳入的 3 组病例共 782 例。无明显外力作用组 334 例，其中椎体内黑色线性信号 114 例； 低能量外力作用组 186 例，其中椎体内黑色线性信号 124 例，高能量外力作用组 262 例，其中椎体内黑色 线性信号 87 例；②3 组间年龄、性别、骨折部位、MRI STIR 黑色线性信号所在椎体部位差异均无显著性意 义(P > 0.05)；③3 组间 MRI STIR 黑色线性信号比较差异有显著性意义(P < 0.05)，分割 P 值，降低检验水 准(α´=0.05/3=0.017)。低能量外力作用组分别与无明显外力作用组、高能量外力作用组比较，差异有显著性 意义(P < 0.017)；无明显外力作用组与高能量外力作用组比较，差异无显著性意义(P > 0.017)；④并且低能 量外力作用组中 MRI STIR 黑色线性信号出现率为 66.7%，明显大于其他 2 组的 43.1%和 33.2%；⑤提示在 创伤史中，相对于无明显外力作用和高能量外力作用，低能量外力作用的骨质疏松性胸腰椎骨折更容易导致 MRI STIR 黑色线性信号的出现，并且多见于胸腰段椎体。 关键词： 骨质疏松；胸腰椎骨折；MRI STIR 黑色线性信号；外力程度 中图分类号：R459.9；R318；R445
《中国组织工程研究》 Chinese Journal of Tissue Engineering Research
骨质疏松性胸腰椎骨折MRI STIR黑色线性信号与外力程度的关系 ·研究原著·
钟远鸣1，罗 满2，唐福波1，唐 成3 (1广西中医药大学第一附属医院，广西壮族自治区南宁市
族自治区南宁市 530001；3柳州市中医医院，广西壮族自治区柳州市 545001)
DOI:10.3969/j.issn.2095-4344.2512
ORCID: 0000-0003-4441-4355(钟远鸣)
530001；2广西国际壮医医院，广西壮
文章快速阅读：
文章特点— (1)回顾性分析骨质疏松胸腰椎骨折病例，采用 Pearsonχ2 检验分析其外力程度与 MRI STIR 椎体中
Zhong Yuanming, Master, Doctoral supervisor, Chief physician, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China
Abstract BACKGROUND: With the aging of the society, the number of patients with osteoporotic vertebral fracture is increasing, mainly manifesting compression fracture of thoracolumbar body, which seriously affects the daily life of the elderly. Therefore, to study the relationship between the degree of external force and the performance of osteoporotic thoracolumbar body fracture on MRI STIR is to provide a better basis for clinical diagnosis and treatment. OBJECTIVE: To explore the relationship between the size of external force and a linear black signal area of STIR image in MRI of thoracic and lumbar osteoporosis vertebral compression fractures. METHODS: The hospitalized patients, who were diagnosed as thoracic and lumbar osteoporosis vertebral compression fractures, were retrospectively analyzed from September 2013 to September 2016 at the Department of Spine Surgery of The First Affiliated Hospital of Guangxi University of Chinese Medicine. All cases in the three groups were diagnosed as osteoporosis by quantitative CT (bone mineral density ≤ 80 mg/cm3). All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into three groups according to the different trauma history: Non-obvious external force group (without apparent cause or external force), low energy group (sprains, bent down to lift heavy objects, and carrying heavy items), high energy group (flat road down hips touchdown, falls, and bruise). Gender, age, fracture site (thoracic lumbar segment and non-thoracic lumbar segment), the number of the vertebrae and the position where would they occur with a linear black signal area of STIR image in MRI were analyzed in each group. Age was analyzed by analysis of variance. Gender, fracture site and the number of the vertebrae and the position were analyzed by Pearson chi-square test. RESULTS AND CONCLUSION: (1) All the 782 cases were included in the three groups. There were 334 in the non-obvious external force group, which a linear black signal area of STIR image in MRI existed in 114 cases. There were 186 cases in low energy group, which a linear black signal area of STIR image in MRI existed in 124 cases. There were 262 cases in high energy group, which a linear black signal area of STIR image in MRI existed in 87 cases. (2) The age, gender, fracture site and the number of the vertebrae and the position in three groups were not statistically significantly different among the three groups (P > 0.05). (3) There were significant differences in a linear black signal area of STIR image in MRI among the three groups (P < 0.05) (α´=0.05/3=0.017). Significant differences were found as compared the low energy group with non-obvious external force group and high energy group (P < 0.017). No significant difference was determined between non-obvious external force group and high energy group (P > 0.017). (4) The occurrence rate of linear black signal area of STIR image in MRI was 66.7% and higher than other groups (43.1% and 33.2%). (5) In the history of trauma, low energy in external force has more opportunity to cause a linear black signal area of STIR image in MRI than non-obvious external force and high energy; and they often occur in thoracic and lumbar osteoporosis vertebrae. Key words: osteoporosis; thoracolumbar compression fracture; linear black signals of MRI STIR; external force
黑色线性信号表现的关系，并观察出现该信号的部位； (2)结果显示，低能量外力作用更容易导致骨质疏松胸腰椎骨折 MRI STIR 椎体中黑色线性信号出现，
且多见于胸腰段椎体，保守治疗往往导致骨折不愈合。希望该结论能为临床骨质疏松胸腰椎骨折 选择保守治疗或者手术治疗提供参考依据。
对象：
(1) 纳 入 骨 质 疏 松 性 胸 腰 椎骨折患者；
文献标识码:B 投稿日期：2017-11-20 送审日期：2017-11-24 采用日期：2019-02-06 在线日期：2019-11-30
试验结果：
低 能 量 外 力 作 用组 更 加 容 易出 现 MRI STIR 椎体黑色线性信号。
观察指标：
3 种创伤程度中，哪种更加容易出现 MRI STIR 椎体黑色线性信号。
Relationship between a linear black signal area of STIR image in MRI of osteoporotic thoracolumbar fracture and the size of external force
Zhong Yuanming1, Luo Man2, Tang Fubo1, Tang Cheng3 (1The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China; 2Guangxi International Zhuang Medical Hospital, Nanning 530001, Guangxi Zhuang Autonomous Region, China; 3Liuzhou Traditional Chinese Medicine Hospital, Liuzhou 545001, Guangxi Zhuang Autonomous Region, China)