本文選題：骨質(zhì)疏松 + 椎體骨折��； 參考：《中國骨質(zhì)疏松雜志》2017年12期

【摘要】：目的分析總結(jié)骨質(zhì)疏松性椎體骨折塌陷(OVC)伴神經(jīng)癥狀(NS)的臨床及影像學特點。方法 2010年8月至2016年6月共40例OVC并NS的患者符合納入標準,女35名,男5名,年齡53~95歲,平均72.4歲,通過檢查側(cè)位X線片、胸腰椎MRI、胸腰椎CT,將骨折分為新鮮期及陳舊期(含骨折不愈合及畸形愈合),陳舊性椎體骨折不愈合根據(jù)骨折部位過伸位CT分為A1(可復(fù)位穩(wěn)定型)、A2(可復(fù)位不穩(wěn)定型)、B(難復(fù)位型),并按椎體塌陷程度及形態(tài)分為輕、中、重、極重度塌陷,極重度塌陷進一步分為扁平型、楔型、凹陷型。記錄患者臨床癥狀、疼痛評分VAS、ASIA神經(jīng)功能分級、體征、骨密度,測量椎體最大塌陷程度、胸腰段后凸角、后壁骨折塊椎管占位率。結(jié)果臨床癥狀:40例患者中,38例(95%)患者有不同程度的胸腰部疼痛;伴下肢神經(jīng)癥狀19例(47.5%);伴肋間神經(jīng)支配區(qū)域放射痛22例(55%);鞍區(qū)麻木伴小便障礙2例;雙側(cè)腹股溝疼痛2例,腰背痛VAS評分0~8分,平均6.6分,神經(jīng)放射痛VAS評分3~8分,平均5.8分,神經(jīng)功能ASIA分級C級5例(12.5%),D級10例(25%),E級25例(62.5%);骨密度平均T=-3.5SD;影像學表現(xiàn):46個受累椎體,陳舊骨折不愈合30例(65.2%),其中A2型56.7%,其次為B型26.7%、A1型16.7%,新鮮骨折13例(28.3%),陳舊骨折畸形愈合3例(6.5%);28個椎體CT發(fā)現(xiàn)椎體內(nèi)"真空征";極重度塌陷椎體共34個(73.9%),楔形50%,凹陷型32.4%,扁平型有17.6%;重度塌陷9例(19.5%),中度塌陷3例(6.5%),無輕度塌陷椎體;36個(78.3%)患椎分布于胸腰段,25/36例(69.4%)胸腰段cobb30°,下腰椎7例,胸椎3例;中央管狹窄30例,椎間孔狹窄10例。結(jié)論骨質(zhì)疏松性椎體塌陷伴神經(jīng)癥狀的臨床表現(xiàn)典型特征為胸腰背部疼痛,體位變動時癥狀加重,臥床休息時可稍減輕或消失。神經(jīng)損害相對較輕,多以下肢根性癥狀或脅肋部區(qū)域神經(jīng)放射痛表現(xiàn)為主,部分表現(xiàn)為動態(tài)神經(jīng)壓迫,還可出現(xiàn)鞍區(qū)麻木及二便障礙。影像學以陳舊不愈合期-A2型為多見,其次為B型,CT往往發(fā)現(xiàn)椎體內(nèi)"真空征",多分布于胸腰段,骨折形態(tài)以極重度塌陷-楔形為主,往往伴有嚴重的后凸畸形及骨質(zhì)疏松,引起中央管狹窄為多。
[Abstract]:Objective to summarize the clinical and imaging features of osteoporotic vertebral fracture (OVC) with neurologic symptoms (NSN).Methods from August 2010 to June 2016, 40 patients with OVC and NS met the inclusion criteria. 35 women, 5 males, aged 5395 years, with an average of 72.4 years, were examined by lateral radiography.Thoracolumbar MRI, thoracolumbar CT, the fracture is divided into fresh and old period (including fracture nonunion and malunion, old vertebral nonunion according to the position of fracture extension CT into A1 (reducible and stable A2)It is difficult to be reduced, and can be divided into light according to the degree and shape of vertebral collapse.Medium, heavy, very severe collapse, very severe collapse is further divided into flat type, wedge type, depression type.The clinical symptoms, pain score, visual nerve function, physical signs, bone mineral density, the maximum degree of vertebral collapse, thoracolumbar kyphosis angle, and the spinal canal occupation rate of posterior wall fracture were recorded.Results of 40 cases with clinical symptoms, 38 cases had chest and waist pain, 19 cases had lower extremity nerve symptoms, 22 cases had intercostal innervation area radiation pain, 2 cases Sellar area numbness with urination disorder, and 2 cases bilateral inguinal pain.The VAS score of low back pain was 0 ~ 8, the average score was 6.6, the VAS score of neuralgia was 3 ~ 8, the average score was 5.8, the ASIA grade of nerve function was C grade, and the 5 cases of grade C with neurologic function ASIA grade C had 25 cases with D grade and 25 cases with D grade, 25 cases with grade E and 25 cases with BMD, the average bone density (BMD) was TG-3.5 SD.Imaging findings: 46 involved vertebrae.There were 30 cases of nonunion of old fractures, of which 56.7 were A2, followed by 16.7b of type B, 13 of fresh fractures, 3 of malunion of old fractures, 28 of which were found to be "vacuum sign" in vertebral body by CT, 34 of which were very severe collapse vertebral body, 50 wedge, 50 wedge, and concave.32.4%, flat type has 17.6x1; severe collapse 9 cases (19.5m), moderate collapse 3 cases (6.5m), no slight collapse vertebral body; (36.78.3%) the thoracic and lumbar segment (cobb30 擄) and lower lumbar vertebrae (78.3C) (25 / 25 / 36 cases); the lower lumbar vertebrae 7 cases, the lower lumbar vertebrae 7 cases, the thoracic and lumbar segment cobb30 擄, the lower lumbar vertebrae 7 cases, the lower lumbar vertebrae 7 cases, the lower lumbar spine 7 cases.Thoracic vertebrae 3 cases, central canal stenosis 30 cases, intervertebral foramen stenosis 10 cases.Conclusion the typical clinical manifestation of osteoporotic vertebral collapse with neurological symptoms is thoracolumbar back pain, the symptoms of postural changes are aggravated, and the symptoms can be slightly alleviated or disappeared during bed rest.The nerve damage was relatively mild. The main symptoms were root symptoms of lower extremities or radialgia in the hypochondrial region, some of them were dynamic nerve compression, and there were numbness and defecation in the Sellar region.The most common imaging features were type A _ 2 in the old nonunion period, and the second was the "vacuum sign" in the vertebral body, which was usually found in the thoracolumbar segment. The fracture was characterized by extremely severe collapse and wedge, and often accompanied by severe kyphosis and osteoporosis.Cause the central duct to narrow as much as possible.
【作者單位】： 廣州中醫(yī)藥大學第一附屬醫(yī)院;廣州中醫(yī)藥大學;
【基金】：基金項目:廣東省科技廳(2016A020215137)
【分類號】：R580;R683

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本文編號：1746502