脊柱结核与化脓性脊柱炎全身与局部骨结构比较△

Comparison of systemic and local bone structures in spinal tuberculosis and suppurative spondylitis

摘要:

［目的］ 比较脊柱结核 （spinal tuberculosis, STB） 和化脓性脊柱炎 （pyogenic spondylitis, PS） 患者的全身骨密度 （bone mineral density, BMD） 与病灶局部骨结构的差异。［方法］ 收集中南大学湘雅医院脊柱外科的脊柱骨质破坏患者 36 例， 分为 STB 组与 PS 组，两组患者按性别进行配对，比较两组全身术前骨密度、病椎与邻椎的 CT 灰度值、术中取出的病灶周围骨组织体积骨量 （bone volume / tissue volume, BV/TV）、骨小梁厚度 （thickness of trabecular bone, Tb.Th） 和骨小梁分离度 （sparse density of trabecular, Tb.Sp）。［结果］ STB 组与 PS 组腰椎总和骨密度、股骨颈部骨密度、转子区骨密度、Ward 三角区骨密度的差异均无统计学意义（P>0.05），PS 患者革兰染色阳性组与阴性组间腰椎总和骨密度、股骨颈部骨密度、转子区骨密度、Ward 三角区骨密度比较，差异均无统计学意义 （P>0.05）。STB 组病椎 CT 灰度值显著大于 PS 组 （P<0.05）。STB 组和 PS 组病灶周围硬化骨质 CT 灰度值均显著增高 （P<0.05），且是 STB 组显著高于 PS 组 （P<0.05）。STB 组的 BV/TV 和 Tb.Th 显著高于 PS 组 （P<0.05），前者的 Tb.Sp 显著小于后者 （P<0.05）。［结论］ 与 PS 相比，脊柱结核患者病灶周围病理性成骨更显著，病灶局部骨小梁密度、厚度增高，但两组患者全身骨密度无显著差异。

Abstract:

[Objective] To compare the general bone mineral density (BMD) and local bone structure around the lesion between spinal tuberculosis (STB) and pyogenic spondylitis (PS) . [Methods] A total of 36 patients who received surgical treatment for spinal bone destruc- tion secondary to infection in the Department of Spine Surgery, Xiangya Hospital, Central South University were enrolled into this study, and divided into spinal tuberculosis (STB) group and pyrogenic spondylitis (PS) group based on the consequence of microbiologic assays. The two groups were paired according to gender, and were compared in terms of the preoperative general BMD, CT grayscales of affected vertebra and adjacent vertebra. In addition, the bone volume/tissue volume (BV/TV) , thickness of trabecular bone (Tb.Th) and sparse densi- ty of trabecular (Tb.Sp) measured on the trabecular bone around the lesion taken out during the operation by micro-CT were compared be- tween the two group. [Results] There were no significant differences between STB group and PS group in terms of the BMDs of the total lum- bar, cervical vertebra, femoral intertrochanteric area and the Ward triangle (P＞0.05) , neither in BMDs of aforesaid areas between the Gram-positive subgroup and Gram-negative subgroup of the PS patients (P＞0.05) . The STB group had significantly higher CT grayscales than the PS group (P＜0.05) . The CT grayscales of sclerosed bone around lesions in both groups significantly increased (P＜0.05) , which in STB group was significantly higher than the PS group (P＜0.05) . In term of micro-CT, the STB group got significantly higher BV/TV and TB. Th, whereas significantly lower Tb.Sp than the PS group (P＜0.05) . [Conclusion] The STB has more vigorous pathological osteogenesis around lesions than the PS, with increase of density and thickness of local bone trabeculae, however, there was no significant difference in general BMD between the two groups.