Scheyerer Max J, Ullrich Bernhard, Osterhoff Georg, Spiegl Ulrich A, Schnake Klaus J
Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln (AöR), Kerpener Straße 62, 50937, Köln, Deutschland.
Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Merseburger Straße 165, 06112, Halle, Deutschland.
Unfallchirurg. 2019 Aug;122(8):654-661. doi: 10.1007/s00113-019-0658-0.
Despite today's good diagnostic and therapeutic options for osteoporosis, the number of unidentified cases is very high and therapy is therefore usually inadequate. Frequently, the diagnosis of osteoporosis is made only after the occurrence of a fracture. The reason for this, apart from the costs incurred as well as the additional radiation exposure of the diagnostics, is certainly the limited availability of dual energy X‑ray absorptiometry (DEXA) as well as quantitative computed tomography (q-CT). In search of an alternative technique, Hounsfield units (HU) of the clinical CT examination proved to be ground-breaking: the results of previous investigations demonstrated a reliable correlation between the T values of the DEXA measurement and the HU of the same vertebral body. Due to the widespread use of clinical CT scans of the thorax and the abdomen for a variety of indications, it is expected that the number of unidentified cases of osteoporosis can be significantly reduced-without additional costs and radiation exposure associated with osteoporosis screening. In addition to osteoporosis diagnostics, the calculated HU may also provide better preoperative planning as well as predicting the further course of the disease. Thus, the risk for vertebral body fractures, screw loosening and cage sintering after ventral fusion operations can be sufficiently predicted. In this way, preoperative modifications to the surgical procedure can be made to reduce the risk of implant failure.
尽管如今骨质疏松症有良好的诊断和治疗方法，但未确诊病例数量仍然很高，因此治疗往往不充分。通常，骨质疏松症只有在骨折发生后才得以诊断。除了诊断成本以及额外的辐射暴露外，双能X线吸收测定法（DEXA）和定量计算机断层扫描（q-CT）的可用性有限肯定也是原因之一。在寻找替代技术的过程中，临床CT检查的亨氏单位（HU）被证明具有开创性：先前的研究结果表明，DEXA测量的T值与同一椎体的HU之间存在可靠的相关性。由于胸部和腹部的临床CT扫描因各种适应症而广泛应用，预计骨质疏松症未确诊病例的数量可以显著减少，而无需与骨质疏松症筛查相关的额外成本和辐射暴露。除了骨质疏松症诊断外，计算得出的HU还可以为术前规划提供更好的依据，并预测疾病的进一步发展。因此，可以充分预测椎体骨折、螺钉松动和前路融合手术后椎间融合器烧结的风险。通过这种方式，可以在术前对手术程序进行调整，以降低植入物失败的风险。
