Kanchiku Tsukasa, Imajo Yasuaki, Suzuki Hidenori, Yoshida Yuichiro, Taguchi Toshihiko
Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
J Spinal Disord Tech. 2014 Apr;27(2):E61-5. doi: 10.1097/BSD.0b013e318292b509.
Retrospective review.
To clarify whether an early magnetic resonance imaging-based classification predicts pseudoarthrosis and final vertebral collapse in osteoporotic vertebral fractures.
Initial therapy for osteoporotic vertebral fractures involves bed rest, orthotic use, and plaster casts. However, in some cases, pain persists because of progressive vertebral collapse or pseudoarthrosis. Prediction of these complications immediately after fractures can facilitate early proactive treatment despite the early prognosis being generally poor.
A total of 109 patients (129 fractured vertebrae, 88 females, 21 males, and average age 79 y) followed up over 6 months after conservative treatment for thoracolumbar vertebral fractures were included. Early midsagittal T1-weighted and T2-weighted magnetic resonance images were analyzed. The incidence of final vertebral body collapse, pseudoarthrosis conversion, and delayed spinal cord paralysis were examined retrospectively for each vertebral fracture type.
According to the T1-weighted image-based classification, 74 of the vertebrae (57%) had total-type fractures. The final vertebral body collapse rate was significantly higher in this type than in others. Pseudoarthrosis was observed in 20 total-type fractures in 20 patients (18.3%); pseudoarthrosis conversion rate was significantly higher in these patients than in others. Delayed spinal cord paralysis occurred in only 1 patient (0.9%) with total-type fracture. According to the T2-weighted image-based classification, 69 vertebrae had the hyperintense wide-type fractures, which was the most common fracture type (53%). Hypointense wide-type fractures were associated with a significantly higher incidence of final vertebral body collapse, pseudoarthrosis, and delayed spinal cord paralysis. When total-type fractures of the T1-weighted image-based classification were subclassified according to the T2-weighted image-based classification, a significantly higher pseudoarthrosis conversion rate was observed in hypointense wide-type fractures.
Our results suggest that the radiologic prognosis can be estimated to a limited extent by determining the degree and extent of osteoporotic vertebral fractures using an early magnetic resonance imaging-based classification.
回顾性研究。
明确基于早期磁共振成像的分类是否能预测骨质疏松性椎体骨折的假关节形成及最终椎体塌陷。
骨质疏松性椎体骨折的初始治疗包括卧床休息、使用矫形器和石膏固定。然而，在某些情况下，由于椎体逐渐塌陷或假关节形成，疼痛会持续存在。尽管骨折后的早期预后通常较差，但在骨折后立即预测这些并发症有助于早期积极治疗。
纳入109例患者（129个骨折椎体，女性88例，男性21例，平均年龄79岁），这些患者在接受胸腰椎椎体骨折保守治疗后随访6个月以上。分析早期矢状面T1加权和T2加权磁共振图像。对每种椎体骨折类型回顾性检查最终椎体塌陷、假关节转化和延迟性脊髓麻痹的发生率。
根据基于T1加权图像的分类，74个椎体（57%）为全型骨折。该类型的最终椎体塌陷率显著高于其他类型。在20例患者的20个全型骨折中观察到假关节形成（18.3%）；这些患者的假关节转化率显著高于其他患者。仅1例全型骨折患者发生延迟性脊髓麻痹（0.9%）。根据基于T2加权图像的分类,69个椎体为高强度宽型骨折，这是最常见的骨折类型（53%）。低强度宽型骨折与最终椎体塌陷、假关节形成和延迟性脊髓麻痹的发生率显著较高相关。当将基于T1加权图像分类的全型骨折根据基于T2加权图像的分类进行亚分类时，低强度宽型骨折的假关节转化率显著较高。
我们的结果表明,通过基于早期磁共振成像的分类确定骨质疏松性椎体骨折的程度和范围，可以在有限程度上估计放射学预后。
