老年中国男性和女性胸腰椎间盘面积形态计量学：基线时的放射学定量和 4 年随访时的变化。

Thoracolumbar Intervertebral Disc Area Morphometry in Elderly Chinese Men and Women: Radiographic Quantifications at Baseline and Changes at Year-4 Follow-up.

机构信息

Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR.

JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR.

出版信息

Spine (Phila Pa 1976). 2018 May 15;43(10):E607-E614. doi: 10.1097/BRS.0000000000002482.

DOI:10.1097/BRS.0000000000002482

PMID:29112101

Abstract

STUDY DESIGN

A population-based radiographic study with longitudinal follow-up.

OBJECTIVE

To develop a quantitative index for lumbar disc space narrowing (DSN) evaluation in elderly subjects; to determine how DSN in the elderly is influenced by osteoporosis and sex.

SUMMARY OF BACKGROUND DATA

There is paucity of research on quantitative classification of lumbar DSN based on disc areal morphometry.

METHODS

With the database of Osteoporotic Fractures in Men (Hong Kong) and Osteoporotic Fractures in Women (Hong Kong) Studies and those who attended the year-4 follow-up (n = 1519 for men and n = 1546 for women), data of 491 women and 592 men were randomly selected. The anterior, middle, and posterior heights; anteroposterior diameter; and area of intervertebral discs (T4T5 to L4L5) were measured on lateral radiographs. Disc area index for lumbar spine (DAIL, disc area divided by the mean of the sum of square of the adjacent upper and lower vertebrae mid-height anterior-posterior diameter) was developed and compared with semiquantitative DSN expert grading.

RESULTS

DAIL correlated with semiquantitative grading, with sensitivity and specificity varying from 87.3% to 96.8% for grade 1 DSN (<30% reduction in disc height), and 92.9% to 100% for grade 3 DSN (>60% reduction in disc height). The thoracolumbar disc area loss among men and women during 4-years' follow-up period varied between 1.32% and 3.56%, and it was greater for women (mean: 2.44%) than for men (mean: 1.90%, P = 0.044). Majority of lumbar DSN progressions during 72 to 76 years old were progression from normal disc space to grade 1 DSN. Osteoporosis was associated with greater disc area decrease, both for thoracic and lumbar discs.

CONCLUSION

Lumbar DSN can be quantified using DAIL. In elderly Chinese, intervertebral disc narrowing over a 4-year period was greater in women than men, and associated with the presence of osteoporosis.

LEVEL OF EVIDENCE

摘要

研究设计

一项基于人群的放射学研究，具有纵向随访。

目的

为评估老年人腰椎间盘狭窄（DSN）开发一个定量指标；确定老年人的 DSN 如何受到骨质疏松症和性别影响。

背景数据摘要

基于椎间盘面积形态计量学的腰椎 DSN 定量分类研究甚少。

方法

利用香港男性骨质疏松性骨折（Hong Kong Osteoporotic Fractures in Men，HOFM）和香港女性骨质疏松性骨折（Hong Kong Osteoporotic Fractures in Women，HOFW）研究数据库，以及参加第 4 年随访的患者（男性 n = 1519，女性 n = 1546），随机选择 491 名女性和 592 名男性的侧位片进行测量。测量椎间盘的前、中、后高度；前-后直径；以及 T4T5 至 L4L5 节段的椎间盘面积。开发了腰椎间盘面积指数（disc area index for lumbar spine，DAIL），并将其与半定量 DSN 专家分级进行比较。

结果

DAIL 与半定量分级相关，1 级 DSN（椎间盘高度减少<30%）的灵敏度和特异性为 87.3%至 96.8%，3 级 DSN（椎间盘高度减少>60%）的灵敏度和特异性为 92.9%至 100%。在 4 年随访期间，男女胸腰椎间盘的面积丢失范围为 1.32%至 3.56%，女性（平均：2.44%）大于男性（平均：1.90%，P = 0.044）。72 至 76 岁时，大多数腰椎 DSN 进展是从正常椎间盘空间进展为 1 级 DSN。骨质疏松症与胸腰椎间盘的面积减少有关。