骨扫描确定多发骨质疏松椎体压缩性骨折责任椎

Bone scan identifying responsible vertebrae of percutaneous vertebroplasty for multiple osteoporotic vertebral compression fractures

摘要:

[目的] 评价骨扫描在诊断多发骨质疏松椎体压缩性骨折 （multiple osteoporotic vertebral compression fractures， MOVCFs）有磁共振（MRI）禁忌的患者中确定责任椎的应用价值。[方法]回顾性研究 2013 年 1 月—2022 年 6 月在本院诊治的 14 例 MOVCFs 患者。所有患者均接受 X 线、CT 和骨扫描成像检查，依据骨扫描成像确定责任椎，行椎体成形术 （percuta- neous vertebroplasty, PVP），评估临床效果。[结果]X 线及 CT 显示 14 例患者共有 32 个椎体压缩性骨折。骨扫描显示有 1 例椎体核素摄取正常；另外 13 例患者中 X 线及 CT 所见共有 30 个椎体楔形变，但只有 17 个楔形变椎体在骨扫描成像中显示出摄取浓聚，骨扫描成像检出阳性率 53.1%。认定为责任椎。13 例患者接受 PVP，其中，9 例为单节段，4 例为双节段。所有患者均顺利完成手术，无并发症。与术前相比，患者术后 1 d 和末次随访时 VAS [(7.9±2.4), (3.6±1.8), (4.1±1.2), P＜0.001] 和 ODI [(42.4±6.8), (12.5±3.1), (14.7±2.9), P＜0.001] 评分均显著下降。[结论] 对于有 MRI 禁忌证的多发骨质疏松椎体压缩性骨折的患者，骨扫描成像是定位责任椎的有效方法。

Abstract:

[Objective] To evaluate the value of bone scan in determining responsible vertebral fractures of percutaneous vertebroplasty in patients who were contraindicated to magnetic resonance imaging (MRI) in the diagnosis of multiple osteoporotic compression fractures (MOVCFs). [Methods] A retrospective study was performed on 14 patients who were treated for MOVCFs in our hospital from January 2013 to June 2022. All patients received X-ray, CT and bone scan examinations. The responsible vertebrae were determined based on bone scan and followed by percutaneous vertebroplasty (PVP) performed. The clinical outcome was evaluated. [Results] X-ray and CT showed a total of 32 vertebral compression fractures in 14 patients. However, bone scan showed that one of them had normal vertebral nuclide uptake, whereas the other 13 patients who had a total of 30 vertebral wedges change seen by X-ray and CT, had only 17 wedged vertebrae with uptake concentration on bone scan imaging, with a positive rate of 53.1% on bone scan imaging. As identified as responsible vertebrae, the 13 patients received PVP, including single segment in 9 cases and double segments in 4 cases. All patients had PVP performed successfully without complications. Compared with those preoperatively, VAS [(7.9± 2.4), (3.6±1.8), (4.1±1.2), P＜0.001] and ODI [(42.4±6.8), (12.5± 3.1), (14.7±2.9), P＜0.001] scores decreased significantly 1 day postoperatively and at the latest follow up. [Conclusion] Bone scan is an effective method to locate the responsible vertebrae in patients with multiple osteoporotic vertebral compression fractures if MRI is contraindicated.