Osteoporosis in acute fractures of the cervical spine: the role of opportunistic CT screening
Osteoporosis in acute fractures of the cervical spine: the role of opportunistic CT screening
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DOI：
10.3171/2014.10.spine14233
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发表时间：
2015-07-01
影响因子：
2.8
通讯作者：
Polly, David W., Jr.
中科院分区：
文献类型：
--
作者：
Emohare, Osa;Dittmer, Alison;Polly, David W., Jr.
对象 最近发布的数据使利用 CT 衰减生成骨矿物质密度 (BMD) 的估计成为可能；这项创新可以节省时间并降低成本。尽管高龄与 BMD 降低相关，尤其是 C-2 骨折患者，但接受过正式双 X 射线吸收测定研究的患者相对较少。据作者所知，这是第一项评估该技术在阐明颈椎急性骨折患者 BMD 方面的效用的研究。 方法 对因颈椎急性骨折而前往 I 级创伤中心并在入院时或受伤前后 6 个月内接受腹部（或 L-1）CT 扫描的患者进行评估。作者使用图片存档和通信系统，在 L-1 体内（不包括皮质）生成了大小相似的感兴趣区域，并计算了 CT 衰减的平均值。将得出的值与阈值进行比较，阈值区分骨质疏松和非骨质疏松状态；还比较了年龄分层组。结果 在审查数据的 91 名患者中，51 名患者年龄≥ 65 岁（平均 43.2 岁），40 名患者年龄 65 岁（平均 80.9 岁）。根据年龄分层的总体平均 CT 衰减值（以 Hounsfield 单位 [HU] 为单位），年轻队列为 193.85 HU，老年队列为 117.39 HU；这两个值之间的比较结果显着（p < 0.001）。 结论 本研究利用机会性 CT 扫描证明了颈椎急性骨折中骨质疏松的相对频率。它还客观地将总体 BMD 与已知的老年患者较高的 C-2 骨折频率相关联。该技术利用了腹部机会性 CT 扫描，这可能会减少与双 X 射线吸收测量扫描相关的额外时间和成本的需求。
OBJECT Recently published data make it possible to generate estimates of bone mineral density (BMD) by using CT attenuation; this innovation can save time and reduce costs. Although advanced age is associated with reduced BMD, especially in patients with a fracture of C-2, relatively few patients ever undergo formal dual x-ray absorptiometry studies. To the authors' knowledge, this is the first study to assess the utility of this technique in elucidating BMD in patients with an acute fracture of the cervical spine.METHODS Patients who presented to a Level I trauma center with an acute fracture of the cervical spine and underwent abdominal (or L-1) CT scanning either at admission or in the 6 months before or after the injury were evaluated. Using a picture-archiving and communication system, the authors generated regions of interest of similar size in the body of L-1 (excluding the cortex) and computed mean values for CT attenuation. The, values derived were compared with threshold values, which differentiate between osteoporotic and nonosteoporotic states; age-stratified groups were also compared.RESULTS Of the 91 patients whose data were reviewed, 51 were >= 65 years old (mean 43.2 years) and 40 were 65 years old (mean 80.9 years). The overall mean CT attenuation values (in Hounsfield units [HU]), stratified according to age, were 193.85 HU for the younger cohort and 117.39 HU for the older cohort; the result of a comparison between these two values was significant (p < 0.001).CONCLUSIONS Using opportunistic CT scanning, this study demonstrates the relative frequency of osteoporosis in acute fractures of the cervical spine. It also objectively correlates overall BMD with the known higher frequency of C-2 fractures in older patients. This technique harnesses the presence of opportunistic CT scans of the abdomen, which potentially reduces the need for the extra time and cost that may be associated with dual x-ray absorptiometry scanning.