Orthopaedic Department, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
Eur Spine J. 2020 May;29(5):1092-1097. doi: 10.1007/s00586-020-06363-1. Epub 2020 Mar 10.
To explore the characteristics of vertebral CT Hounsfield units (HU) in elderly patients with acute vertebral fragility fractures.
A total of 299 patients aged ≥ 65 years with acute vertebral fragility fractures were retrospectively reviewed, and 77 patients of them were age- and sex-matched with 77 control patients without any fractures. The vertebral HU value of L1(L1-HU) was measured, and T12 and L2 were used as alternatives for L1 in the case of L1 fracture.
There were 460 thoracic and lumbar vertebral fractures in the 299 elderly patients, including 349 acute vertebral fragility fractures and 111 chronic fractures. The average L1-HU value was 66.0 ± 30.6 HU and showed significant difference among patients having different numbers of vertebral fractures (one fracture: 73.3 ± 27.0 HU, two fractures: 58.7 ± 32.5 HU, three or more fractures: 40.7 ± 28.8 HU; P < 0.001). As for the 1:1 age- and sex-matched patients, the L1-HU of the 77 patients with fractures was lower than that of the control patients (70.6 ± 23.4 HU vs. 101.5 ± 36.2 HU, P < 0.001). The area under the receiver operating characteristic curve of using L1-HU to differentiate patients with fractures from controls was 0.77(95% CI 0.70-0.85, P < 0.001). The cutoff value had high specificity of 90% or high sensitivity of 90% to identify patients with fractures of 60 HU and 100 HU, respectively.
The elderly patients with acute vertebral fragility fractures have much lower HU values than those without fractures. Moreover, the lower the vertebral HU value is, the more likely the patients have more than one vertebral fracture. These slides can be retrieved under Electronic Supplementary Material.
探讨老年急性脊柱脆性骨折患者的 CT 椎体 Hounsfield 单位（HU）特征。
回顾性分析 299 例年龄≥65 岁的急性脊柱脆性骨折患者，其中 77 例患者与 77 例无骨折的年龄和性别匹配的对照组患者。测量 L1 椎体 HU 值（L1-HU），如果 L1 骨折，用 T12 和 L2 替代 L1。
299 例老年患者共发生 460 个胸腰椎骨折，其中 349 例为急性脊柱脆性骨折，111 例为慢性骨折。平均 L1-HU 值为 66.0±30.6 HU，不同骨折例数的患者 L1-HU 值存在显著差异（1 个骨折：73.3±27.0 HU，2 个骨折：58.7±32.5 HU，3 个及以上骨折：40.7±28.8 HU；P<0.001）。对于 1:1 年龄和性别匹配的患者，骨折组的 L1-HU 值低于对照组（70.6±23.4 HU 比 101.5±36.2 HU，P<0.001）。使用 L1-HU 值区分骨折患者和对照组患者的受试者工作特征曲线下面积为 0.77（95%CI 0.70-0.85，P<0.001）。当 L1-HU 值为 60 HU 和 100 HU 时，对骨折患者的识别具有较高的特异性（90%）或较高的敏感性（90%）。
急性脊柱脆性骨折的老年患者的 HU 值明显低于无骨折患者。此外，椎体 HU 值越低，患者发生多个椎体骨折的可能性越大。这些幻灯片可在电子补充材料中检索。
