摘要
目的:利用腰椎CT值来评估强直性脊柱炎患者骨质疏松以及骨质疏松性椎体骨折和螺钉松动的情况。方法:回顾性分析2002年1月~2017年12月在我院住院并手术的27例强直性脊柱炎患者骨密度资料。双能X线骨密度测定法(dualenergy X-ray absorptiometry,DXA)检查结果T值>-1为骨量正常,T值-2.5^-1为骨量减少,T值<-2.5为骨质疏松。L1椎体平均CT值<100HU诊断骨质疏松,100~160HU之间为骨量减少,160HU以上为骨量正常。用SPSS统计软件进行分析,经Kappa检验评估以及Mann-Whitney U检验比较DXA和CT值评估强直性脊柱炎患者中骨质疏松以及骨质疏松性椎体骨折和螺钉松动情况。结果:27例患者中,使用传统DXA方法测量骨质疏松患者16例,骨量减少患者6例,骨量正常患者5例;用CT值测量骨质疏松患者16例,骨量减少患者9例,骨量正常患者2例,经Kappa检验两者一致性差,两种方法评估骨质疏松存在差异,通过Mann-Whitney U检验比较骨质疏松的常见并发症骨质疏松性椎体骨折,发现CT值评估骨量情况的患者在椎体骨折组和非骨折组分布存在差异性(CT值诊断为骨质疏松的患者更易同时并发骨质疏松性骨折)(P=0.009),而DXA评估骨量情况的患者在椎体骨折组以及非骨折组分部无统计学差异(P=0.095)。CT值诊断为骨质疏松的强直性脊柱炎患者在螺钉松动组以及非螺钉松动组分布无显著性差异(P=0.272),DXA诊断骨质疏松的强直性脊柱炎患者在螺钉松动组以及非螺钉松动组分布无显著性差异(P=0.610)。结论:CT值和DXA方法测量强直性脊柱炎患者骨密度情况一致性差,在骨质疏松性椎体骨折中应用CT值评估强直性脊柱炎患者骨质疏松情况比传统DXA有一定的优势,但本身也存在一定局限性。
Objectives:Our purpose was to use computed tomography(CT)Hounsfield unit(HU)values to identify the osteoporosis and fragility fractures in patients with ankylosing spondylitis diseases.Methods:From January 2002 to December 2017,a total of 27 patients with ankylosing spondylitis diseases were retrospectively reviewed.Both CT and dualenergy X-ray absorptiometry(DXA)were used to identify the osteoporosis in those patients.Normal bone mass,osteopenia,osteoporosis were identified according to DXA T>-1;-2.5<T<-1;T<-2.5 and CT scan L1 HU>160 HU,100 HU<L1 HU<160 HU,L1 HU<100 HU.Osteoporosis,fragility fractures and screw loosening were valued in patients with ankylosing spondylitis diseases by using SPSS 23 software for analysis,Kappa test for evaluation and Mann-Whitney U test for comparison.Results:Among all 49 patients,only 27 had both DXA and CT data.Measured with DXA value,16 patients were with osteoporosis,6 patients with osteopenia,and 5 patients with normal bone mass;while measured with CT value,16 patients were with osteoporosis,9 patients with bone loss,and 2 patients with normal bone mass.After examined the Kappa consistency,a difference between both methods was found.Through the Mann-Whitney U test on osteoporotic vertebral fracture,a common complication of osteoporosis,the distribution of patients with bone mass assessed by CT value was different in the vertebral fracture group and the non-fracture group(patients diagnosed with osteoporosis by CT value were more likely to have concurrent osteoporotic fractures)(P=0.009),while there was no statistically significant difference between patients with bone mass assessed by DXA in the vertebral fracture group and the non-fracture group(P=0.095).In the screw loose group and the non-screw loose group,there was no significant difference in the distribution of patients with ankylosing spondylitis diagnosed by CT(P=0.272),neither by DXA(P=0.610).Conclusions:The consistency of CT value and DXA method in the measurement of bone density in patients with ankylosing spondyli
作者
邓超
李危石
邹达
钟沃权
DENG Chao;LI Weishi;ZOU Da(Department of Orthopedics,Peking University Third Hospital,Beijing,100191,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2020年第5期393-398,共6页
Chinese Journal of Spine and Spinal Cord
基金
北京大学第三医院临床队列建设项目(编号:BYSYDL2019006)。
关键词
CT值
强直性脊柱炎
骨质疏松
椎体骨折
双能X线骨密度测定法
Computed tomography hounsfield unit
Ankylosing spondylitis
Osteoporosis
Vertebral fracture
Dualenergy X-ray absorptiometry
