应用影像学技术分析骨质疏松症患者胸腰椎椎弓根下骨孔形态特征与 Kummell 病的相关性。

Correlation analysis between morphologic characteristics of the thoracolumbar basivertebral foramen and Kummell's disease in patients with osteoporosis using imaging techniques.

机构信息

Department of Orthopaedic Surgery, Affiliated Liutie Centarl Hospital of GuangXi Medical University, Guangxi Province, Liuzhou, China.

Department of Orthopaedic Surgery, Hechi People's Hospital, Guangxi Province, Hechi, China.

出版信息

BMC Musculoskelet Disord. 2023 Jun 23;24(1):513. doi: 10.1186/s12891-023-06609-1.

BACKGROUND

The aging of the population is a social problem faced by many countries in the world. With the increase in the elderly population, the number of patients with Kummell's disease is also gradually increasing. No study has demonstrated that Kummell's disease has a clear correlation with the foramen of a vertebrobasilar vein.

OBJECTIVES

The research was conducted to describe and evaluate the morphological characteristics of a basivertebral foramen in patients with osteoporosis and Kummell's disease by CT; to infer whether the specific morphological characteristics of basivertebral foramen may be one of the risk factors of Kummell's disease; to provide clinical suggestions for the treatment of Kummell's disease.

DESIGN

Retrospective analysis from January 2020 to December 2021 on 83 patients with 83 vertebral bodies (T8-L5) diagnosed with senile osteoporosis and Kummell's disease hospitalized in our hospital due to chronic low back pain, including 57 women and 23 men. Group A was assigned for the following patients: the age ranged from 59 to 86 years old, with the average age of 67.30 ± 7.32 years old; the body mass index ranged from 20.01 to 29.46 kg/m, with the average body mass index of 23.51 ± 3.03 kg/m.Group B was assigned for the following patients: 83 patients diagnosed with senile osteoporosis in our outpatient department from January 2020 to December 2021, including 41 males and 42 females; the age ranged from 60 to 85 years, with an average age of 68.52 ± 4.68 years old; the height to weight ratio met the normal reference standard (except 20% above or 10% below the standard weight). Through the lanwon PACS imaging system, the related parameters of the vertebrobasilar foramen in patients with osteoporosis and Kummell's disease were measured to evaluate and analyze the correlation between the morphological characteristics of the vertebrobasilar foramen in patients with osteoporosis and Kummell's disease.

RESULTS

In patients with osteoporosis, the distribution of incidence rate of Kummell's disease in the spine was consistent with that of osteoporotic compression fractures. Sagittal view of the vertebral body on CT scan and the triangular-shaped, trapezoidal-shaped, and irregular-shaped basivertebral foramen in group A accounted for 18%,57%,and 36%,respectively. In group B, triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen accounted for 51%,17%,and 26%,respectively.The distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen was compared between groups A and B, and the difference was recorded as statistically significant (P < 0.05). Additionally, the difference in the distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen in group A was found statistically significant (P < 0.05),while that of Group B was found statistically insignificant (P > 0.05).On a horizontal CT scan of the vertebra of group A, triangles, trapezoids, and irregularities accounted for 28%, 26%, and 47%, respectively. In group B, triangles,trapezoids,and irregularities accounted for 31%, 37%, and 30%, respectively. The difference in the distribution of the triangular-shaped and trapezoidal-shaped foramen in groups A and B was statistically insignificant (P > 0.05), while that of irregular-shaped was statistically significant (P < 0.05). Additionally, there was no statistical significance (P > 0.05) in the difference in the morphological distribution of triangular-shaped and trapezoidal-shaped foramen in group A, while that of irregular-shaped was found to be statistically significant (P < 0.05). Further, the difference in the morphological distribution of triangular-shaped, trapezoidal-shaped, and irregular-shaped foramen in group B was not statistically significant (P > 0.05).In general, about 8% of the vertebral body of BF has an osseous septum. In group A, 97% are single-holed while the remaining 3% are porous; in group B, those with single holes accounted for 76%, while the remaining 24% are porous. In groups A and B, the difference in the morphological distribution of single-holed and multi-holed T8, T11, T12, L1, L2, L4, and L5 vertebral bodies was statistically significant (P < 0.05). In group A, the difference in the distribution of single-holed and multi-holed L1 and L5 vertebral bodies was statistically significant (P < 0.05). Similarly, the difference in the distribution of single-holed and multi-holed T8, T11, T12, L1, L2, and L4 basivertebral foramen was statistically significant (P < 0.05).

CONCLUSIONS

In patients with osteoporosis, the incidence of vertebral Kummell's disease can be associated with the morphological characteristics of the basivertebral foramen, as observed in the CT scan. Furthermore, the vertebral body with trapezoidal-shaped and irregular-shaped basivertebral foramen and boneless septum in the foramen is highly susceptible to Kummell's disease.

背景

人口老龄化是世界上许多国家面临的一个社会问题。随着老年人口的增加，Kummell 病的患者数量也在逐渐增加。目前尚无研究表明 Kummell 病与椎基底静脉孔有明确的相关性。

目的

通过 CT 描述和评估骨质疏松性 Kummell 病患者的椎基底孔形态特征，推断椎基底孔的特定形态特征是否可能是 Kummell 病的一个危险因素，为 Kummell 病的治疗提供临床建议。

设计

回顾性分析 2020 年 1 月至 2021 年 12 月在我院因慢性腰痛住院的 83 例 T8-L5 骨质疏松性 Kummell 病患者的 83 个椎体（T8-L5）的临床资料，其中女性 57 例，男性 23 例。A 组患者年龄 59 ～ 86 岁，平均年龄 67.30±7.32 岁，体质量指数 20.01 ～ 29.46 kg/m²，平均体质量指数 23.51±3.03 kg/m²；B 组患者为同期我院门诊诊断为骨质疏松症的 83 例患者，男 41 例，女 42 例，年龄 60 ～ 85 岁，平均年龄 68.52±4.68 岁，身高体重指数符合正常参考标准（除标准体重上下 20%和 10%外）。通过 lanwon PACS 影像系统测量骨质疏松症合并 Kummell 病患者的椎基底孔相关参数，评估和分析骨质疏松症合并 Kummell 病患者椎基底孔形态特征的相关性。

结果

骨质疏松患者 Kummell 病的发病部位分布与骨质疏松性压缩性骨折一致。A 组 CT 扫描椎体矢状位可见三角形、梯形和不规则形椎基底孔分别占 18%、57%和 36%。B 组中，三角形、梯形和不规则形孔分别占 51%、17%和 26%。A 组和 B 组的三角形、梯形和不规则形孔分布比较，差异有统计学意义（P<0.05）。此外，A 组中三角形、梯形和不规则形孔的分布差异有统计学意义（P<0.05），而 B 组的差异无统计学意义（P>0.05）。A 组椎体水平 CT 扫描上的三角形、梯形和不规则形分别占 28%、26%和 47%。B 组中三角形、梯形和不规则形分别占 31%、37%和 30%。A 组和 B 组三角形和梯形孔的分布差异无统计学意义（P>0.05），而不规则形孔的分布差异有统计学意义（P<0.05）。此外，A 组中三角形和梯形孔形态分布的差异无统计学意义（P>0.05），而不规则形孔的差异有统计学意义（P<0.05）。B 组中三角形、梯形和不规则形孔形态分布的差异无统计学意义（P>0.05）。一般情况下，BF 的椎体约有 8%有骨性隔。A 组中，97%为单孔，3%为多孔；B 组中，单孔占 76%，多孔占 24%。A 组和 B 组 T8、T11、T12、L1、L2、L4、L5 椎体单孔和多孔的形态分布差异有统计学意义（P<0.05）。A 组中 L1 和 L5 椎体单孔和多孔的分布差异有统计学意义（P<0.05）。同样，A 组 T8、T11、T12、L1、L2、L4 椎基底孔单孔和多孔的分布差异有统计学意义（P<0.05）。