老年男性 MRI 椎体裂隙征患者的骨微结构和代谢。

Bone microarchitecture and metabolism in elderly male patients with signs of intravertebral cleft on MRI.

机构信息

Department of Spine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, China.

School of Medicine, Shandong University, Jinan, 250000, China.

出版信息

Eur Radiol. 2022 Jun;32(6):3931-3943. doi: 10.1007/s00330-021-08458-9. Epub 2022 Jan 6.

DOI:10.1007/s00330-021-08458-9

PMID:34989849

Abstract

OBJECTIVES

Intravertebral cleft (IVC) is a common but not unique imaging manifestation in Kümmell's disease. To date, great controversy exists regarding the specific mechanisms of IVC. In this study, we aimed to investigate the characteristics of microarchitecture and metabolism in patients with IVC and to analyse the correlations between degree of vertebral collapse and risk factors.

METHODS

A total of 79 elderly men were included in this study. We divided all patients into two groups: the IVC group (30 patients) and the non-IVC group (49 patients). We compared the differences in microarchitecture and bone turnover marker (BTM) serum concentrations between the groups and analysed risk factors affecting vertebral collapse by using the Mann-Whitney U test and Spearman's correlation test.

RESULTS

Quantitative analysis of the microarchitecture showed higher content of necrotic bone (p < 0.001) and lower content of lamellar bone (p < 0.001) in the IVC group. Analysis of BTMs identified lower concentration of N-terminal propeptide of type I collagen (PINP, p = 0.002) and higher concentration of β-isomerized C-terminal telopeptide (β-CTX, p < 0.001) in the IVC group. The correlation analysis showed that lamellar bone content (p < 0.001) and spine T-score (p = 0.011) were significantly correlated with the degree of vertebral collapse.

CONCLUSIONS

IVC is a radiological feature of excessive bone resorption by higher activities of osteoclasts and decreased bone remodelling ability by lower activities of osteoblasts. Histomorphological feature in patients with IVC is delayed callus mineralisation, which may increase the risk of vertebral collapse.

KEY POINTS

• A key histomorphological feature in patients with IVC is delayed callus mineralisation, which may aggravate the degree of vertebral collapse. • We investigated bone metabolism in patients with IVC to evaluate the activities of osteoclasts and osteoblasts directly. • We propose a novel hypothesis for the pathogenesis of IVC: bone resorption by higher activity of osteoclasts and decreased callus mineralisation ability by lower activity of osteoblasts are the main mechanisms leading to IVC.

摘要

目的

椎体内裂隙（IVC）是 Kümmell 病的一种常见但非独特的影像学表现。迄今为止，关于 IVC 的具体机制仍存在很大争议。本研究旨在探讨 IVC 患者的微结构和代谢特征，并分析椎体塌陷程度与危险因素之间的相关性。

方法

本研究共纳入 79 例老年男性患者。我们将所有患者分为两组：IVC 组（30 例）和非 IVC 组（49 例）。我们比较了两组之间微结构和骨转换标志物（BTM）血清浓度的差异，并通过 Mann-Whitney U 检验和 Spearman 相关检验分析了影响椎体塌陷的危险因素。

结果

微结构的定量分析显示，IVC 组的坏死骨含量较高（p<0.001），板层骨含量较低（p<0.001）。BTM 分析显示，IVC 组的 I 型胶原氨基端前肽（PINP，p=0.002）浓度较低，β-异构型 C 端肽（β-CTX，p<0.001）浓度较高。相关性分析显示，板层骨含量（p<0.001）和脊柱 T 评分（p=0.011）与椎体塌陷程度显著相关。