| 任昶旭,葛晓勇,张树宝,杨进,王善金*.基于CT测量的椎体HU值对腰椎后路椎间融合内固定术后近端交界区椎体骨折的预测价值[J].脊柱外科杂志,2024,22(6):374-378. |
基于CT测量的椎体HU值对腰椎后路椎间融合内固定术后近端交界区椎体骨折的预测价值  点此下载全文 (Fulltext) |
| 任昶旭 葛晓勇 张树宝 杨进 王善金* |
| 同济大学附属东方医院脊柱外科, 上海 200120 |
| 基金项目：浦东新区卫生健康委员会学科带头人培养计划项目（PWRd2020-11）;浦东新区卫生健康委员会卫生科技联合攻关项目（PW2023D-12）;浦东新区卫生系统学科建设特色专病项目（PWZzb2022-22） |
| DOI：10.3969/j.issn.1672-2957.2024.06.004 |
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| 摘要： |
| 目的 探讨基于CT测量的椎体HU值对腰椎退行性疾病患者采用后路腰椎椎间融合术（PLIF）治疗后继发近端交界区椎体骨折（PJVF）的预测作用。方法 回顾性分析2013年1月—2015年12月因腰椎退行性疾病采用PLIF治疗的241例患者临床资料，根据是否发生PJVF分为PJVF组（n=23）和non-PJVF组（n=218）。收集2组患者年龄、性别、体质量指数（BMI）、糖尿病史、高血压病史、美国麻醉师协会（ASA）分级、校正钙磷乘积、固定节段数、是否融合至S1、L1平均HU值，并于术后1、3、6和12个月随访时行影像学复查以评估是否发生PJVF并记录骨折节段和类型。对术后发生PJVF的独立危险因素进行logistic回归分析，并绘制受试者工作特征（ROC）曲线，计算ROC曲线下面积（AUC），分析椎体平均HU值对术后发生PJVF的预测作用。结果 2组在年龄、性别、校正钙磷乘积、固定节段数、L1平均HU值5个方面差异有统计学意义（P <0.05）；将差异有统计学意义的指标作为潜在危险因素纳入logistic回归分析，结果显示，年龄、校正钙磷乘积、固定节段数、L1平均HU值是PLIF术后发生PJVF的独立危险因素。通过绘制ROC曲线并计算AUC得出，L1平均HU值预测PJVF的效果良好，AUC为0.871，约登指数最佳临界值为109.3，灵敏度和特异度分别为83%和80%。结论 高龄、更低的校正钙磷乘积、更多的固定节段数和更低的L1平均HU值是PLIF术后发生PJVF的独立危险因素。基于CT测量的椎体HU值对PLIF术后继发PJVF有较好的预测效能。 |
| 关键词：腰椎 椎间盘退行性变 骨质疏松 脊柱融合术 手术后并发症 脊柱骨折 |
| Predictive value of vertebral HU value based on CT measurement for proximal junctional vertebral fractures after posterior lumbar interbody fusion Fulltext |
| Ren Changxu Ge Xiaoyong Zhang Shubao Yang Jin Wang Shanjin |
| Department of Spinal Surgery, East Hospital, Tongji University, Shanghai 200120, China |
| Fund Project: |
| Abstract: |
| Objective To explore the predictive value of vertebral HU value based on CT measurement for proximal junctional vertebral fractures（PJVF） after posterior lumbar interbody fusion（PLIF） in patients with lumbar degenerative diseases. Methods The data of 241 patients treated with PLIF due to lumbar degenerative diseases from January 2013 to December 2015 were retrospectively analyzed，and the patients were divided into PJVF group（n=23） and non-PJVF group（n=218） according to whether PJVF occurred. Age，gender，body mass index（BMI），history of diabetes，history of hypertension，American Society of Anesthesiologists（ASA） classification，corrected calcium-phosphorus product，number of fixed segments，fusion to S1 and L1 average HU value were collected in the 2 groups. Imaging data was followed up at postoperative 1，3，6，and 12 months to assess the occurrence of PJVF and to record the fracture segment and type. Logistic regression analysis was performed on the independent risk factors for postoperative PJVF，and receiver operating characteristic（ROC） curve was drawn and the area under ROC curve（AUC） was calculated to analyze the predictive effect of average vertebral HU value on postoperative PJVF. Results There were significant differences in age，gender，corrected calcium-phosphorus product，number of fixed segments and L1 average HU value between the 2 groups（P <0.05）. Indicators with statistical significance for the difference were included in logistic regression analysis as potential risk factors. The results showed that age，corrected calcium-phosphorus product，number of fixed segments and L1 average HU value were independent risk factors for PJVF after PLIF. By drawing the ROC curve and calculating the AUC，it was concluded that the L1 average HU value had a good effect on predicting PJVF. The AUC was 0.871，the optimal critical value of Youden index was 109.3，and the sensitivity and specificity were 83% and 80%，respectively. Conclusions Advanced age，lower corrected calcium-phosphorus product，more fixed segments and lower L1 average HU value are independent risk factors for PJVF after PLIF. The vertebral HU value based on CT measurement has good predictive efficacy for secondary PJVF after PLIF. |
| Keywords:Lumbar vertebrae Intervertebral disc degeneration Osteoporosis Spinal fusion Postoperative complications Spine fracture |
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