在 CT 矢状位上低 Hounsfield 单位值预测短节段脊柱融合术后椎体骨折。
Low hounsfield unit values at sagittal section on computed tomography predicts vertebral fracture following short spinal fusion.
机构信息
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan.
Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Sakyo, Kyoto, 606-8507, Japan.
出版信息
J Orthop Sci. 2024 May;29(3):726-733. doi: 10.1016/j.jos.2023.03.008. Epub 2023 Mar 21.
BACKGROUND
Preoperative identification of osteoporosis during spine surgery is of critical importance. Additionally, the Hounsfield units (HU) measured using computed tomography (CT) have gained considerable attention. This study aimed to propose a more accurate and convenient screening method for predicting vertebral fractures after spinal fusion in elderly patients by analyzing the HU value of different range of interests of thoracolumbar spine.
METHODS
Our sample pool for analysis consisted of 137 elderly female patients aged >70 years who underwent one- or two-level spinal fusion surgery with a diagnosis of adult degenerative lumbar disease. The HU values of the anterior 1/3 of the vertebral bodies based on sagittal plane and those of vertebral bodies based on axial plane at T11-L5 were measured using the perioperative CT. The incidence of postoperative vertebral fractures with respect to the HU value was investigated.
RESULTS
Vertebral fractures were identified in 16 patients during the mean follow-up period of 3.8 years. While no significant association was found between HU value of L1 vertebral body or minimum HU value from axial plane and the incidence of the postoperative vertebral fracture, the minimum vertebral HU value of the anterior 1/3 of vertebral body from sagittal plane was associated with the incidence of the postoperative vertebral fracture. Patients with a minimum anterior 1/3 vertebral HU value of <80 had a higher incidence of postoperative vertebral fractures. The adjacent vertebral fractures occurred at the level of the vertebra with the lowest HU value, with a high probability. The existence of the vertebra with a minimum HU value of <80 within two levels of upper instrumented vertebrae was a risk factor for adjacent vertebral fracture.
CONCLUSION
HU measurement of the anterior 1/3 of vertebral body predicts the risk of vertebral fracture after short spinal fusion surgery.
背景
脊柱手术前识别骨质疏松症至关重要。此外，计算机断层扫描（CT）测量的 Hounsfield 单位（HU）也受到了广泛关注。本研究旨在通过分析胸腰椎不同感兴趣区的 HU 值，提出一种更准确、更方便的预测老年脊柱融合术后椎体骨折的筛查方法。
方法
我们的分析样本池包括 137 名年龄>70 岁的老年女性患者，这些患者因成人退行性腰椎疾病行单或双节段脊柱融合术。在矢状面测量基于前 1/3 椎体的 HU 值，在 T11-L5 轴位测量基于椎体的 HU 值，使用围手术期 CT 进行测量。研究术后 HU 值与椎体骨折发生率的关系。
结果
在平均 3.8 年的随访期间，16 名患者发生了术后椎体骨折。虽然 L1 椎体 HU 值或轴向最小 HU 值与术后椎体骨折发生率之间无显著相关性，但矢状面椎体前 1/3 的最小椎体 HU 值与术后椎体骨折发生率相关。最小前 1/3 椎体 HU 值<80 的患者术后椎体骨折发生率较高。相邻椎体骨折发生在 HU 值最低的椎体水平，概率较高。上下固定节段内存在最小 HU 值<80 的椎体是相邻椎体骨折的危险因素。
结论
椎体前 1/3 的 HU 值测量可预测短节段脊柱融合术后椎体骨折的风险。
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