Schröder Guido, Flachsmeyer Dirk, Kullen Claus Maximilian, Andresen Julian Ramin, Schulze Marko, Hiepe Laura, Schober Hans-Christof, Andresen Reimer
Klinik für Orthopädie und Unfallchirurgie, Warnow Klinik Bützow, Am Forsthof 3, 18246, Bützow, Deutschland.
Institut für Diagnostische und Interventionelle Radiologie/Neuroradiologie, Westküstenklinikum Heide, Akademisches Lehrkrankenhaus der Universitäten Kiel, Lübeck und Hamburg, Heide, Deutschland.
Orthopadie (Heidelb). 2022 Jul;51(7):547-555. doi: 10.1007/s00132-022-04261-6. Epub 2022 May 23.
The risk of osteoporotic insufficiency fractures (Fx) at the axial skeleton increases with decreasing bone density, with an accumulation in the thoracic and thoracolumbar regions. To better understand the differential distribution of Fx along the spine, morphological and osteodensitometric studies were performed by computed tomography (CT) in the various spine sections. In addition, we aimed to clarify whether Hounsfield units (HU) found on CT examinations from other indications correlate with bone density and could be grounds for osteologic diagnosis.
The entire spines of 26 body donors were fixed in a Plexiglas water phantom and analyzed by high-resolution spiral CT. In addition, CT morphological cancellous bone density was measured in HU from C3 to S2 (624 vertebral bodies). Bone mineral density (BMD, mg/ml) was calculated and used to estimate osteoporosis (OPO).
OPO was present in all spines. Significantly increased sintering fractures were found in the thoracic and thoracolumbar regions when BMD was below 60 mg/ml. Fx in the cervical spine area were not found overall. Cancellous bone density was significantly higher in the cervical (median 188.6 HU) than in the lumbar (median 63.6 HU) and sacral (median 25.5 HU) spine.
BMD loss of vertebral body cancellous bone leads to an increased risk of Fx, which is also found in the cadaver spines. However, an apparent threshold for the occurrence of sintering fractures is not undercut in the cervical region. Finding a threshold for HU would be relevant to clinical practice.
随着骨密度降低，轴向骨骼发生骨质疏松性不全骨折（Fx）的风险增加，且在胸椎和胸腰段区域有累积。为了更好地理解脊柱上Fx的差异分布，通过计算机断层扫描（CT）对脊柱各节段进行了形态学和骨密度测量研究。此外，我们旨在阐明其他适应症的CT检查中发现的亨氏单位（HU）是否与骨密度相关，以及是否可作为骨病诊断的依据。
将26具尸体捐赠者的整个脊柱固定在有机玻璃水模体中，并用高分辨率螺旋CT进行分析。此外，测量了从C3到S2（624个椎体）的HU中的CT形态学松质骨密度。计算骨矿物质密度（BMD，mg/ml）并用于评估骨质疏松症（OPO）。
所有脊柱均存在OPO。当BMD低于60mg/ml时，在胸椎和胸腰段区域发现明显增加的压缩性骨折。总体上未发现颈椎区域的骨折。颈椎（中位数188.6HU）的松质骨密度显著高于腰椎（中位数63.6HU）和骶椎（中位数25.5HU）。
椎体松质骨的BMD降低会导致Fx风险增加，这在尸体脊柱中也有发现。然而，颈椎区域并未突破压缩性骨折发生的明显阈值。找到HU的阈值将与临床实践相关。
