Mirovsky Yigal, Anekstein Yoram, Shalmon Ehud, Peer Amir
Spine Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
AJNR Am J Neuroradiol. 2005 Aug;26(7):1634-40.
The appearance of vacuum clefts (VCs) of the vertebral bodies has frequently been considered pathognomonic for avascular necrosis. Until recently, this was considered to be a rare finding that might indicate excessive motion at the fracture site. Our aim in this retrospective study was to determine the occurrence and location of these clefts in patients with osteoporotic vertebral fractures and evaluate the risk factors involved for developing these clefts in such patients.
The records of 66 patients with 101 painful osteoporotic vertebral fractures who were treated by vertebroplasty in our department were reviewed. All the fractures with VCs were collected. Age, sex, degree of deformity, and extent of degenerative changes in the adjacent disk space were compared with those found in the patients without clefts.
VCs were found in 26 fractured vertebrae of 26 patients. They were significantly more common in elderly men who had deformed fractures located at the thoracolumbar junction, when compared with fractures without clefts, especially when degenerative changes were observed in the adjacent disk space.
This study suggests that VCs, which have long been considered pathognomonic for avascular necrosis (Kümmell disease), are not rare and most probably represent fracture nonunion. Elderly patients who have deformed fractures at the thoracolumbar area have a higher risk for developing clefts, mainly when there is degeneration of the adjacent disk space.
椎体真空裂隙（VCs）的出现常被视为无血管性坏死的特征性表现。直到最近，这一发现仍被认为较为罕见，可能提示骨折部位存在过度活动。本回顾性研究的目的是确定骨质疏松性椎体骨折患者中这些裂隙的发生率及位置，并评估此类患者发生这些裂隙的危险因素。
回顾了在我科接受椎体成形术治疗的66例患有101处疼痛性骨质疏松性椎体骨折患者的记录。收集所有存在VCs的骨折病例。将有VCs骨折患者的年龄、性别、畸形程度以及相邻椎间盘间隙退变程度与无裂隙患者进行比较。
在26例患者的26个骨折椎体中发现了VCs。与无裂隙的骨折相比，VCs在胸腰段交界处发生畸形骨折的老年男性中更为常见，尤其是当相邻椎间盘间隙出现退变时。
本研究表明，长期以来被视为无血管性坏死（Kümmell病）特征性表现的VCs并非罕见，很可能代表骨折不愈合。胸腰段发生畸形骨折的老年患者发生裂隙的风险较高，主要是在相邻椎间盘间隙出现退变时。
