Hasegawa K, Homma T, Uchiyama S, Takahashi H
Department of Orthopaedic Surgery, Niigata Cancer Center Hospital, Japan.
Spine (Phila Pa 1976). 1998 Oct 15;23(20):2201-6. doi: 10.1097/00007632-199810150-00011.
Radiologic and operative findings of intravertebral cleft in the osteoporotic spine were investigated and the pathomechanism discussed.
To clarify the pathologic features of the intravertebral cleft.
Intravertebral "vacuum" cleft is one of the common radiographic findings in the osteoporotic spine. It is thought that the cleft is a rare lesion of an ununited fracture, or pseudarthrosis. Evidential findings of the disease, however, have never been reported.
Simple bone grafting was performed in five cases (average age, 76.8 years) of thoracolumbar intravertebral cleft in osteoporotic spine in patients who had been suffering from prolonged pain of the back or leg. Preoperative radiologic evaluation using flexion-extension radiograph and magnetic resonance imaging was performed in all patients. At operation, the cleft and the components of the structure were macroscopically and microscopically observed. The fluid content in the cleft was biochemically analyzed.
In all patients, preoperative flexion-extension radiographs showed intravertebral instability at the location of the clefts that indicated gas density in three cases and water density in two cases. Magnetic resonance imaging showed that, for the most part, the cleft was low intensity on the T1-weighted image and high intensity on the T2-weighted scans, regardless of the radiographic findings. At operation, abnormal movement was observed at the cleft of the affected body, which was covered with hypertrophic membrane. The serous fluid within the cleft was aspirated before the excision of soft tissue. The thick membrane was excised and showed that the cleft was lined by smooth fibrocartilaginous tissue and the great degree of motion between the fracture ends that is consistent with the pathologic appearance of pseudarthrosis.
The unstable cleft in the affected vertebral body of the osteoporotic spine with magnetic resonance findings of low intensity on the T1-weighted scans and high intensity on the T2-weighted scans suggests that the cleft is a false joint lined by fibrocartilaginous tissue with notable movement consistent with pseudarthrosis.
对骨质疏松性脊柱椎体内裂隙的影像学和手术发现进行研究，并探讨其发病机制。
阐明椎体内裂隙的病理特征。
椎体内“真空”裂隙是骨质疏松性脊柱常见的影像学表现之一。人们认为该裂隙是一种罕见的未愈合骨折或假关节病变。然而，该病的确切证据尚未见报道。
对5例（平均年龄76.8岁）患有胸腰椎骨质疏松性脊柱椎体内裂隙且长期背痛或腿痛的患者进行单纯植骨手术。所有患者术前均采用屈伸位X线片和磁共振成像进行影像学评估。手术中，对裂隙及其结构组成部分进行宏观和微观观察。对裂隙内的液体成分进行生化分析。
所有患者术前屈伸位X线片均显示裂隙部位存在椎体不稳定，其中3例显示气体密度，2例显示液体密度。磁共振成像显示，无论X线表现如何，大多数情况下，裂隙在T1加权像上呈低信号，在T2加权像上呈高信号。手术中，观察到患椎裂隙处有异常活动，周围覆盖有肥厚的膜。在切除软组织前，吸出裂隙内的浆液。切除增厚的膜后发现，裂隙内衬有光滑的纤维软骨组织，骨折端之间有很大程度的活动，这与假关节的病理表现一致。
骨质疏松性脊柱患椎的不稳定裂隙在磁共振成像上表现为T1加权像低信号、T2加权像高信号，提示该裂隙是一个由纤维软骨组织衬里的假关节，有明显活动，符合假关节表现。
