椎体骨折影像类型与椎体成形术疗效关系探讨

摘 要 目的:为探讨椎体骨折影像类型与椎体成形术疗效的关系。方法:采用椎体成形术治疗骨质疏松性胸腰椎骨折348例。按椎体骨折影像学形态改变将骨折病例分为5种类型:Ⅰ型:无变形型32例;Ⅱ型:单纯压缩型75例;Ⅲ型:非后缘崩裂型139例;Ⅳ型:后缘崩裂形65例;Ⅴ型:椎管轻度占位型37例。将五种型椎体骨折病例椎体成形术疗效进行比较分析。结果:随访6～12个月,5种类型中术后疗效以Ⅰ型疗效最佳,完全缓解(CR)率100%。Ⅱ型CR率94.67%,Ⅲ型CR率88.49%,Ⅳ型CR率86.15%,Ⅴ型CR率86.49%。疗效对比结果:除Ⅱ型与Ⅰ型之间对比结果差异无显著性外,其他类型与Ⅰ型对比结果差异均有显著性。结论:胸腰椎骨折影像诊断类型与椎体成形术疗效、风险直接相关,有重要临床意义。

关键词 椎体骨折 影像类型 椎体成形术 疗效

doi:10.3969/j.issn.1007-614x.2010.22.194

Discussing relation both Image types for vertebral body fractures and curative effect of Percutaneous Verebroplasty

MA jun-shan,GAO jing-chun,MI shi-jun,Fengrun People’s Hospital of Tangshan,Tangshan 064000,Hebei,China

AbstractObjective:To explore relation between Image type for vertebral body fractures and curative effects of Percutaneous Verebroplasty (PVP).Methods:348 patients with osteoporotic vertebral body fractures in thoracic vertebral or lumbar vertebral were treated by PVP.Before the operation,According to their shapes on Image,vertebral body fracture were divide to 5 types. model Ⅰ,no shape change type 32 cases;Model Ⅱ,simple compressed type 75 cases;model Ⅲ,crack not at back fringe type 139 cases;model Ⅳ,crack at back fringe type 65 cases;model Ⅴ,osseous debris intrude canalis vertebralis type 37 parison curative effects and cement leak rate between model Ⅰwith other one model.Results:Follow-up 6～12 months, find to that modelⅠcurative effect was best.32 cases the symptoms complete remission (CR) at all,the CR rate was 100%.Model Ⅱ 75 cases,the CR rate was 94.67%.model Ⅲ 139 cases,the CR rate was 88.49%.model Ⅳ 65 cases,the CR rate was 86.14%. model Ⅴ 37 ases,the CR rate was 86.49%.Curative effect contrast results:Cement leak out vertebral body contrast results were same with Curative effect contrast.Conclusions:Image types for vertebral body fractures with curative effect and risks of PVP there are direct relation,there are important significance at clinic.

Key wordsVertebral body fractures;Image type;Percutaneous Verebroplasty;Curative effect

胸腰椎骨折诊断除了根据临床表现外,最常用的辅助诊断便是影像学诊断,对减少误诊误治提高诊断治疗的精准度起到至关重要的作用。

自2001年11月～2009年6月,我们共完成经皮穿刺椎体成型术348例,所有患者术前均做伤椎X线片、CT及MRI检查,对椎体骨折病例进行影像学分型,并将各类型椎体骨折疗效加以比较,报告如下。

资料与方法

病人资料:男86例,女262例,男:女=1:3.28;年龄50～92岁,平均66.52岁。

设备与材料:日立磁共振机,飞利浦X线机,飞利浦多排CT,莫非氏骨活检针,ZIMER骨水泥。

检查方法:对怀疑有胸腰椎椎体骨折的患者做伤椎MRI、X线片及CT检查。MRI图像用来确立椎体骨折诊断:伤椎表现T1加权像为低信号、T2加权像高信号可确立椎体骨折诊断。伤椎X线片用来估计椎体压缩程度:椎体高度损失

影像学分型:我们按椎体骨折有无压缩、合并崩裂、崩裂的部位及椎管占位情况,参考脊柱骨折的Gertzbein综合分类中的A型 [1]结合Denis的三柱理论,将适合单纯椎体成形术的崩裂型椎体骨折病例分为5个临床类型。

Ⅰ型(椎体无变形型):X线片无明显椎体压缩及变形改变,磁共振图像可见受伤椎体水肿信号改变,CT检查见受伤椎体骨纹理断裂的症状性椎体骨折;损伤限于前柱、中柱者。

Ⅱ型(单纯压缩型):椎体压缩性骨折,X光片有明显椎体压缩及变形改变,磁共振图像可见受伤椎体水肿信号改变,CT伤椎无明显终板崩裂及椎体骨皮质裂隙的症状性椎体骨折,损伤限于前柱、中柱者。

Ⅲ型(非椎体后缘崩裂型):椎体压缩骨折伴有椎体崩裂,椎体崩裂限于前缘、侧缘以及上下终板,裂缝未抵达椎体后缘,损伤限于前、中柱损伤者。

Ⅳ型(椎体后缘崩裂型):椎体压缩骨折伴有明显崩裂,骨折裂缝已抵达椎体后缘者, 损伤限于前、中柱者。