Mariconda M, Lotti G, Fava R, Midolo R, Longo C, Milano C
Via L. Caldieri 132, 80128 Naples, Italy.
Eur Spine J. 2004 Jul;13(4):346-53. doi: 10.1007/s00586-003-0646-4. Epub 2004 Feb 10.
A cross-sectional study was conducted to evaluate the possible use of a low-cost radiation-free technique in the prediction of degenerative changes in the lumbar spine. Although an inverse correlation between osteoporosis and degenerative changes in the lumbar spine has been reported, no previous studies have asked whether there is a correlation between calcaneal quantitative ultrasound results and degenerative findings in the lumbar spine. In 117 patients with low back pain or pain in the lower limb, ultrasonographic parameters (speed of sound, broadband ultrasound attenuation, stiffness) of the calcaneus were correlated with evidence of degenerative changes and stenosis on magnetic resonance scans of the lumbar spine. Linear and logistic regression, as well as receiver operator characteristic curve analyses, were used to evaluate the correlation. Lumbar spine stenosis was associated with elevated calcaneal ultrasonographic parameters, particularly speed of sound. For the identification of a narrowing of the lumbar spinal canal below 100 mm(2) of dural sac cross-sectional area, speed of sound showed 89% sensitivity and 75% specificity in males older than 60 years. In male patients, we also found a significant positive correlation between ultrasonographic parameters and scores on a degenerative scale that primarily reflects intervertebral disc degeneration ( P=0.019 for speed of sound; P=0.039 for stiffness). In conclusion, calcaneal quantitative ultrasound is frequently used in elderly patients with low back pain as a diagnostic test for osteoporosis. The incidental finding of high values on ultrasonographic parameters in these subjects, particularly in males, is highly correlated with lumbar spine degeneration and stenosis, and can help to identify those symptomatic patients needing more extensive diagnostic testing.
开展了一项横断面研究，以评估一种低成本无辐射技术在预测腰椎退变方面的可能用途。尽管已有报道称骨质疏松与腰椎退变之间存在负相关，但此前尚无研究探讨跟骨定量超声结果与腰椎退变表现之间是否存在关联。在117例腰痛或下肢疼痛患者中，将跟骨的超声参数（声速、宽带超声衰减、硬度）与腰椎磁共振扫描显示的退变和狭窄证据进行关联分析。采用线性回归、逻辑回归以及受试者工作特征曲线分析来评估相关性。腰椎管狭窄与跟骨超声参数升高有关，尤其是声速。对于识别硬膜囊横截面积小于100 mm²的腰椎管狭窄，声速在60岁以上男性中显示出89%的灵敏度和75%的特异度。在男性患者中，我们还发现超声参数与主要反映椎间盘退变的退变量表评分之间存在显著正相关（声速P = 0.019；硬度P = 0.039）。总之，跟骨定量超声在老年腰痛患者中经常作为骨质疏松的诊断检查使用。这些受试者，尤其是男性，超声参数出现高值这一偶然发现与腰椎退变和狭窄高度相关，有助于识别那些需要更广泛诊断检查的有症状患者。
