本文關(guān)鍵詞： 骨質(zhì)疏松 椎體骨折 脊椎CT 脊椎MR　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的分析常規(guī)胸腰椎CT和MR椎體骨折診斷的漏診情況,以提高放射科醫(yī)生及臨床醫(yī)生對(duì)骨折漏診的及規(guī)范的骨質(zhì)疏松骨折治療的重視。資料和方法分別回顧分析住院治療的年齡大于45歲且臨床主訴及分別申請(qǐng)CT及MR檢查的原因均與骨質(zhì)疏松癥、腫瘤和骨折無(wú)關(guān)的808例(男性329例,女性479例)脊椎CT矢狀重建圖像及相應(yīng)報(bào)告及1040例(男性:473例,女性:567例)脊椎MR矢狀位圖像及相應(yīng)報(bào)告。依據(jù)Genant' s半定量(semiquantitative)法進(jìn)行椎體形態(tài)評(píng)估和骨折及骨折分度判定,分別記錄諸患者椎體壓縮性骨折發(fā)生部位及程度,并將評(píng)估結(jié)果與其既往CT報(bào)告、MR報(bào)告、DXA檢查結(jié)果、出院有關(guān)骨質(zhì)疏松癥的診斷和治療信息分別進(jìn)行比較分析。結(jié)果分析808例椎體CT矢狀重建圖像,共計(jì)發(fā)生椎體骨164例,其中單發(fā)椎體骨折106例/個(gè)(64.6%)。CT影像報(bào)告已診斷壓縮骨折者75例,CT影像報(bào)告未診斷椎體骨折89例(54.27%)。漏診椎體個(gè)數(shù)115個(gè),其中Ⅰ度椎體壓縮骨折未報(bào)告椎體個(gè)數(shù)108個(gè)。所有報(bào)告均未判定椎體骨質(zhì)疏松性骨折程度。在放射科診斷并報(bào)告的75例中,行DXA檢查者僅有16例,出院時(shí)明確骨質(zhì)疏松癥診斷者6例,出院予骨質(zhì)疏松藥物者僅21例。分析1040例MR矢狀位圖像中,共有265例(25.48%)發(fā)生椎體骨折,其中單發(fā)椎體骨折161例(60.75%)。MR報(bào)告明確診斷椎體骨折者僅89例(33.58%),未診斷椎體骨折176例(66.42%),漏診骨折椎體個(gè)數(shù)247個(gè),其中輕度壓縮骨折224個(gè)(90.69%),中度壓縮骨折20個(gè)(8.10%)。在MR報(bào)告椎體骨折者的89例中,28例椎體骨折同時(shí)伴隨骨髓水腫的發(fā)生,放射科明確報(bào)告椎體骨髓水腫的僅14例(14/28,50%)。所有報(bào)告均未判定椎體骨質(zhì)疏松性骨折程度。另外,診斷椎體骨折的89例中,僅20例(22.47%)進(jìn)行了 DXA檢查。49例(55.06%)在出院診斷中診斷了骨質(zhì)疏松性骨折。僅28例(31.46%)對(duì)骨質(zhì)疏松性骨折進(jìn)行了臨床的藥物治療或干預(yù)。結(jié)論骨質(zhì)疏松性骨折在椎體CT矢狀重建影像及MR矢狀位圖像上較易忽視,尤其是輕度椎體骨折。另外,對(duì)于放射科已報(bào)告的椎體骨折,臨床干預(yù)及治療也尚有不完善之處。因此,放射科醫(yī)生和相關(guān)臨床醫(yī)生應(yīng)對(duì)椎體形態(tài)的判定足夠重視,相信有助于臨床醫(yī)師對(duì)骨質(zhì)疏松癥的防治的方案制定。
[Abstract]:Objective to analyze the missed diagnosis of conventional thoracolumbar vertebral fractures by CT and Mr. In order to increase the attention of radiologists and clinicians to the treatment of osteoporotic fractures with missed diagnosis and standard treatment, the data and methods the data and methods the data and methods of the hospitalized patients over 45 years old and clinical complaint and CT application were analyzed retrospectively. And the causes of Mr examination were correlated with osteoporosis. There were 808 cases (male 329, female 479) which had nothing to do with tumor and fracture. Sagittal reconstruction and corresponding report of vertebral CT were performed in 1040 cases (male: 473). Spinal MRI sagittal image and corresponding report. According to Genant's semi-quantitative semiquantitative method. Method to evaluate the shape of vertebral body and to judge fracture and fracture grading. The location and extent of vertebral compression fracture were recorded, and the results were compared with the previous CT reports and DXA findings. Results the sagittal reconstruction images of 808 cases of vertebral body CT were analyzed, 164 cases of vertebral body bone occurred. Among the 106 cases of single vertebral body fracture, 75 cases were diagnosed by CT imaging. Ct images showed that 89 cases of vertebral fracture were not diagnosed and 115 cases were missed. The number of vertebral body was not reported in 108 cases of first degree vertebral compression fracture. All the reports did not determine the extent of osteoporotic fracture of vertebral body. In 75 cases diagnosed and reported by radiology, only 16 cases were examined by DXA. 6 cases were diagnosed as osteoporosis at discharge, only 21 cases were treated with osteoporosis drugs. Among 1040 cases of sagittal Mr images, 265 cases (25. 48%) had vertebral fracture. Among the 161 cases with single vertebral body fracture, only 89 cases (33.58%) were diagnosed by Mr report, and 176 cases (66.42%) were not diagnosed. The number of missed fractures was 247, including 224 cases with mild compression fractures (90.69%) and 20 cases with moderate compression fractures (8.10%). 28 cases of vertebral body fracture accompanied by bone marrow edema, radiologists clearly reported vertebral bone marrow edema in only 14 cases of 14 / 28. All the reports did not determine the extent of osteoporotic fracture of vertebral body. In addition, 89 cases of vertebral fracture were diagnosed. Only 20 cases (22. 47) were examined by DXA. 49 cases (55.06) were diagnosed in the diagnosis of osteoporotic fracture. Only 28 cases (31. 46%). Conclusion Osteoporosis fracture is easy to be ignored in sagittal reconstruction of vertebral body and Mr sagittal image. In addition, the clinical intervention and treatment of vertebral fracture reported by radiology department is not perfect. Radiologists and related clinicians should pay enough attention to the determination of vertebral body morphology, which is helpful for clinicians to make plans for the prevention and treatment of osteoporosis.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R683;R816.8;R445.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 余衛(wèi);姚金鵬;林強(qiáng);牟文斌;;胸側(cè)位像椎體壓縮骨折診斷忽視原因淺析[J];中華放射學(xué)雜志;2010年05期

2 ;骨質(zhì)疏松及骨礦鹽疾病診療指南(討論稿)[J];國(guó)際內(nèi)分泌代謝雜志;2006年04期

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本文編號(hào)：1449840