Lane John I, Maus Timothy P, Wald John T, Thielen Kent R, Bobra Shalabh, Luetmer Patrick H
Mayo Clinic, Department of Radiology, Section of Neuroradiology, Rochester, MN 55902, USA.
AJNR Am J Neuroradiol. 2002 Nov-Dec;23(10):1642-6.
Intravertebral clefts have long been considered as pathognomonic for avascular necrosis and as a rare cause of compression fracture. We have observed unsuspected clefts opacifying frequently during vertebroplasty. Our purpose in this study was to determine the incidence of these clefts in symptomatic osteoporotic compression fractures, assess the sensitivity of MR imaging and conventional radiography in the detection of these clefts, and determine whether there is any prognostic significance of these clefts in patients treated with vertebroplasty.
Retrospective chart reviews were conducted of 135 vertebroplasty procedures performed during a 2-year period. MR images and conventional radiographs were reviewed for the presence of clefts defined as fluid-filled cavities on MR images or gas-filled cavities on conventional radiographs. Digital radiographs obtained at the time of the procedure were inspected for the presence of opacified clefts. Imaging findings were correlated with subjective pain scores documented before the procedure and at 1 week, 1 month, 6 months, and 12 months after vertebroplasty.
Two hundred thirty-six osteoporotic compression fractures were treated with polymethylmethacrylate in 125 patients. Thirty-one and eight-tenths percent of the fractures were noted to contain clefts at the time of vertebroplasty. Fluid-filled clefts were detected on preoperative MR images in only 52.8% of the fractures with opacified clefts at vertebroplasty. Gas-filled clefts were evident on preoperative conventional radiographs in only 11.4% of the fractures with opacified clefts at vertebroplasty. No significant difference was noted in numerical pain scores between the two populations at baseline or 1 week or 1 month after the procedure. Pain scores at 6 and 12 months after vertebroplasty showed a trend toward greater pain relief in patients with clefts, although the difference was not statistically significant. A sustained, statistically significant decrease in pain scores after treatment (P <.01) was noted in both groups.
Intravertebral clefts are much more common than previously described and probably represent fracture nonunions. Imaging is not sensitive in detecting these clefts before vertebroplasty. We advocate complete filling of the cleft with cement during vertebroplasty to maximize stabilization of the fracture fragments. There is a trend toward greater pain relief being achieved 6 and 12 months after the procedure in patients with clefts that are opacified at the time of vertebroplasty.
长期以来，椎体内裂隙一直被视为无血管性坏死的特征性表现，也是压缩性骨折的罕见原因。我们观察到在椎体成形术中，这些未曾预料到的裂隙常常会显影。本研究的目的是确定这些裂隙在有症状的骨质疏松性压缩性骨折中的发生率，评估磁共振成像（MR成像）和传统X线摄影在检测这些裂隙方面的敏感性，并确定这些裂隙在接受椎体成形术治疗的患者中是否具有任何预后意义。
对在2年期间进行的135例椎体成形术进行回顾性病历审查。回顾MR图像和传统X线片，以检查是否存在裂隙，裂隙在MR图像上定义为充满液体的腔隙，在传统X线片上定义为充满气体的腔隙。检查手术时获得的数字X线片，以查看是否存在显影的裂隙。将影像学检查结果与手术前以及椎体成形术后1周、1个月、6个月和12个月记录的主观疼痛评分进行关联。
125例患者的236处骨质疏松性压缩性骨折接受了聚甲基丙烯酸甲酯治疗。在椎体成形术时，31.8%的骨折被发现含有裂隙。在椎体成形术时有显影裂隙的骨折中，术前MR图像仅检测到52.8%的充满液体的裂隙。在椎体成形术时有显影裂隙的骨折中，术前传统X线片仅11.4%显示有充满气体的裂隙。在基线时以及手术后1周或1个月，两组患者的数字疼痛评分没有显著差异。椎体成形术后6个月和12个月时，有裂隙患者的疼痛评分显示出疼痛缓解程度更大的趋势，尽管差异无统计学意义。两组患者在治疗后疼痛评分均出现持续的、具有统计学意义的下降（P<.01）。
椎体内裂隙比先前描述的更为常见，可能代表骨折不愈合。在椎体成形术前，影像学检查对检测这些裂隙不敏感。我们主张在椎体成形术中用骨水泥完全填充裂隙，以最大程度地稳定骨折碎片。在椎体成形术时有显影裂隙的患者中，术后6个月和12个月时疼痛缓解程度有更大的趋势。
