骨质疏松性椎体骨折塌陷伴神经症状的临床及影像学特点

发布时间：2018-04-13 22:30

本文选题：骨质疏松 + 椎体骨折　；参考：《中国骨质疏松杂志》2017年12期

【摘要】：目的分析总结骨质疏松性椎体骨折塌陷(OVC)伴神经症状(NS)的临床及影像学特点。方法 2010年8月至2016年6月共40例OVC并NS的患者符合纳入标准,女35名,男5名,年龄53~95岁,平均72.4岁,通过检查侧位X线片、胸腰椎MRI、胸腰椎CT,将骨折分为新鲜期及陈旧期(含骨折不愈合及畸形愈合),陈旧性椎体骨折不愈合根据骨折部位过伸位CT分为A1(可复位稳定型)、A2(可复位不稳定型)、B(难复位型),并按椎体塌陷程度及形态分为轻、中、重、极重度塌陷,极重度塌陷进一步分为扁平型、楔型、凹陷型。记录患者临床症状、疼痛评分VAS、ASIA神经功能分级、体征、骨密度,测量椎体最大塌陷程度、胸腰段后凸角、后壁骨折块椎管占位率。结果临床症状:40例患者中,38例(95%)患者有不同程度的胸腰部疼痛;伴下肢神经症状19例(47.5%);伴肋间神经支配区域放射痛22例(55%);鞍区麻木伴小便障碍2例;双侧腹股沟疼痛2例,腰背痛VAS评分0~8分,平均6.6分,神经放射痛VAS评分3~8分,平均5.8分,神经功能ASIA分级C级5例(12.5%),D级10例(25%),E级25例(62.5%);骨密度平均T=-3.5SD;影像学表现:46个受累椎体,陈旧骨折不愈合30例(65.2%),其中A2型56.7%,其次为B型26.7%、A1型16.7%,新鲜骨折13例(28.3%),陈旧骨折畸形愈合3例(6.5%);28个椎体CT发现椎体内"真空征";极重度塌陷椎体共34个(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%),无轻度塌陷椎体;36个(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;中央管狭窄30例,椎间孔狭窄10例。结论骨质疏松性椎体塌陷伴神经症状的临床表现典型特征为胸腰背部疼痛,体位变动时症状加重,卧床休息时可稍减轻或消失。神经损害相对较轻,多以下肢根性症状或胁肋部区域神经放射痛表现为主,部分表现为动态神经压迫,还可出现鞍区麻木及二便障碍。影像学以陈旧不愈合期-A2型为多见,其次为B型,CT往往发现椎体内"真空征",多分布于胸腰段,骨折形态以极重度塌陷-楔形为主,往往伴有严重的后凸畸形及骨质疏松,引起中央管狭窄为多。
[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 掳) 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 掳, 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.
【作者单位】：广州中医药大学第一附属医院;广州中医药大学;
【基金】：基金项目:广东省科技厅(2016A020215137)
【分类号】：R580;R683

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