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一项关于使用磁共振成像对急性下背痛老年女性隐匿性椎体骨折患病率及初步诊断准确性的临床前瞻性观察队列研究。

A Clinical Prospective Observational Cohort Study on the Prevalence and Primary Diagnostic Accuracy of Occult Vertebral Fractures in Aged Women with Acute Lower Back Pain Using Magnetic Resonance Imaging.

作者信息

Terakado Atsushi, Orita Sumihisa, Inage Kazuhide, Kubota Go, Kanzaki Tomohiro, Mori Hiroshi, Shinohara Yuji, Nakamura Junichi, Matsuura Yusuke, Aoki Yasuchika, Furuya Takeo, Koda Masao, Ohtori Seiji

机构信息

Kitachiba Spine and Sports Clinic, Chiba, Japan.

Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

出版信息

Pain Res Manag. 2017;2017:9265259. doi: 10.1155/2017/9265259. Epub 2017 May 25.

DOI:10.1155/2017/9265259
PMID:28630567
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5463094/
Abstract

BACKGROUND

Elderly female patients complaints of acute low back pain (LBP) may involve vertebral fracture (VF), among which occult VF (OVF: early-stage VF without any morphological change) is often missed to be detected by primary X-ray examination. The current study aimed to investigate the prevalence of VF and OVF and the diagnostic accuracy of the initial X-ray in detecting OVF.

METHOD

Subjects were elderly women (>70 years old) complaining of acute LBP with an accurate onset date. Subjects underwent lumbar X-ray, magnetic resonance imaging (MRI), and bone mineral density (BMD) measurement at their first visit. The distribution of radiological findings from X-ray and magnetic resonance imaging (MRI) as well as the calculation of the prevalence of VF and OVF are investigated.

RESULTS

The prevalence of VF among elderly women with LBP was 76.5% and L1 was the most commonly injured level. Among VF cases, the prevalence of OVF was 33.3%. Furthermore, osteoporotic patients tend to show increased prevalence of VF (87.5%). The predictive values in detecting VF on the initial plain X-ray were as follows: sensitivity, 51.3%; specificity, 75.0%; and accuracy rate, 56.7%.

CONCLUSIONS

Acute LBP patients may suffer vertebral injury with almost no morphologic change in X-ray, which can be detected using MRI.

摘要

背景

老年女性患者急性腰痛（LBP）可能涉及椎体骨折（VF），其中隐匿性椎体骨折（OVF：早期椎体骨折，无任何形态学改变）常被初次X线检查漏诊。本研究旨在调查椎体骨折和隐匿性椎体骨折的患病率以及初次X线检查对隐匿性椎体骨折的诊断准确性。

方法

研究对象为年龄>70岁、有准确起病日期的急性腰痛老年女性。研究对象在首次就诊时接受腰椎X线、磁共振成像（MRI）和骨密度（BMD）测量。研究X线和磁共振成像（MRI）的影像学表现分布以及椎体骨折和隐匿性椎体骨折患病率的计算。

结果

老年腰痛女性中椎体骨折的患病率为76.5%，L1是最常受累节段。在椎体骨折病例中，隐匿性椎体骨折的患病率为33.3%。此外，骨质疏松患者的椎体骨折患病率往往更高（87.5%）。初次X线平片检测椎体骨折的预测值如下：敏感性为51.3%；特异性为75.0%；准确率为56.7%。

结论

急性腰痛患者可能存在X线几乎无形态学改变的椎体损伤，而MRI可检测出此类损伤。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/ad2bbe269a03/PRM2017-9265259.006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/a6902ae2eda4/PRM2017-9265259.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/bf692ac74ac7/PRM2017-9265259.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/235e55d69838/PRM2017-9265259.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/1f326c262419/PRM2017-9265259.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/f3fe4535258e/PRM2017-9265259.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/ad2bbe269a03/PRM2017-9265259.006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/a6902ae2eda4/PRM2017-9265259.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/bf692ac74ac7/PRM2017-9265259.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/235e55d69838/PRM2017-9265259.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/1f326c262419/PRM2017-9265259.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/f3fe4535258e/PRM2017-9265259.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07ba/5463094/ad2bbe269a03/PRM2017-9265259.006.jpg

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