骨质疏松性椎体压缩骨折患者腰椎椎基静脉孔的CT影像解剖学研究

doi:10.13418/j.issn.1001-165x.2023.3.07

摘要/Abstract

摘要： 目的观察骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fracture，OVCF）患者腰椎椎基静脉孔（basivertebral foramen，BVF）形态学特征。方法选取腰椎OVCF患者107例，在CT三维重建图像上观察BVF数目和形态，测量BVF宽（basivertebral foramen width，BFW），深（basivertebral foramen depth，BFD），高（basivertebral foramen height，BFH），宽、深、高相对值（BFWr、BFDr、BFHr），距椎体左、右缘距离（left vertebral body width，VWL；right vertebral body width，VWR），距椎体上、下终板的距离（vertebral body up，VHU；vertebral body below，VHB）。用SPSS25.0软件进行分析。结果腰椎BVF多为单孔型，CT冠状面多呈矩形，横断面多呈三角形或梯形。平均BFW（7.8±1.6）mm，BFD（12.4±2.1）mm，BFH（5.4±1.1）mm。BVF平均宽、深、高分别占椎体同一平面宽、深、高的1/5、2/5、1/4。L1、L3 VWL与VWR无统计学差异（P>0.05），L2、L4和L5 VWL与VWR有统计学差异（P<0.05）。VHU与VHB有统计学差异（P<0.05），BVF更靠近上终板。结论 OVCF患者行骨水泥注射时，根据BVF解剖学特点确定穿刺靶点位置和骨水泥注入量，有利于预防骨水泥椎管内渗漏。

关键词: 骨质疏松性椎体压缩骨折； , , 腰椎； , , 椎基静脉孔；CT三维重建

Abstract: Objective To observe the morphological characteristics of basivertebral foramen (BVF) in patients with osteoporotic vertebral compression fracture (OVCF). Methods One hundred and seven cases of lumbar OVCF patients were studied. The number and morphology of BVF were observed on CT images. The basivertebral foramen width (BFW), basivertebral foramen depth (BFD), basivertebral foramen height (BFH), BFW relative value (BFWr), BFD relative value (BFDr), BFH relative value (BFHr), left vertebral body width (VWL), right vertebral body width (VWR), vertebral body up (VHU) and vertebral body below (VHB) were measured. All the data were analyzed by SPSS25.0 software. Results Most BVF were single-hole type, rectangular on coronal images and triangular or trapezoidal on horizontal images. The average width of BVF was (7.8±1.6) mm, average depth was (12.4±2.1) mm and average height was (5.4±1.1) mm. The average width, depth and height of BVF respectively accounted for 1/5, 2/5 and 1/4 of the vertebral body width, depth and height. There was no statistical difference between VWL and VWR in L1 and L3 (P>0.05), but there were statistical differences between VWL and VWR in L2, L4 and L5 (P<0.05). There were statistical differences between VHU and VHB (P<0.05), and BVF was closer to the upper endplate. Conclusions The puncture target position and amount of bone cement are determined in surgery according to the morphological characteristics and anatomical data of BVF, which is beneficial for preventing bone cement leakage.

Key words: Osteoporotic vertebral compression fracture; , , Lumbar vertebrae; , , Basivertebral foramen, CT 3D reconstruction

中图分类号:

R322
R683.2

何艾岭, 王清, 李广州. 骨质疏松性椎体压缩骨折患者腰椎椎基静脉孔的CT影像解剖学研究[J]. 中国临床解剖学杂志, 2023, 41(3): 283-287.

He Ailing, Wang Qing, Li Guangzhou. CT imaging anatomical study of lumbar vertebral basivertebral foramen in elderly patients with osteoporotic vertebral compression fractures[J]. Chinese Journal of Clinical Anatomy, 2023, 41(3): 283-287.

参考文献 17

[1]	Buchbinder R, Johnston RV, Rischin KJ, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J]. Cochrane Database Syst Rev, 2018, 11(11): CD006349. DOI: 10.1002/14651858.CD006349.pub4.
[2]	Lee JK, Jeong H, Joo IH, et al. Percutaneous balloon kyphoplasty for the treatment of very severe osteoporotic vertebral compression fractures: a case-control study[J]. Spine J, 2018, 18(6): 962-969. DOI: 10.1016/j.spinee.2017.10.006.
[3]	Hsieh MK, Kao FC, Chiu PY, et al. Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty[J]. J Orthop Surg Res, 2019, 14(1): 1-8. DOI: 10.1186/s13018-019-1459-4.
[4]	Tang B, Cui L, Chen X, et al. Risk factors for cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: an analysis of 1456 vertebrae augmented by low-viscosity bone cement[J]. Spine, 2021, 46(4): 216-222. DOI: 10.1097/BRS.0000000000003773.
[5]	Yang H, Chen L, Zheng Z, et al. Therapeutic effects analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a multicentre study[J]. J Orthop Translat, 2017, 11: 73-77. DOI: 10.1016/j.jot.2017.04.003.
[6]	Batson OV. The function of the vertebral veins and their role in the spread of metastases[J]. Ann Surg, 1940, 112(1): 138. DOI: 10.1097/00000658-194007000-00016.
[7]	Tzika M, Paraskevas GK, Piagkou M, et al. Basivertebral foramina of true vertebrae: morphometry, topography and clinical considerations[J]. Surg Radiol Anat, 2021, 43(6): 889-907. DOI: 10.1007/s00276-021-02690-0.
[8]	康小燕, 李洁, 王星, 等. 胸椎椎基静脉孔的CT影像学观测[J]. 中国临床解剖学杂志, 2015, 33(6): 641-645. DOI: 10.13418/j.issn.1001-165x.2015.06.006.
[9]	马春明, 鞠晓华, 王孝文, 等. 腰椎椎基静脉孔的解剖学观测及其临床意义[J]. 中国临床解剖学杂志, 2014, 32(4): 405-408. DOI: 10.13418/j.issn.1001-165x.2014.04.008.
[10]	王素春, 施建东, 陆爱清, 等. 椎基静脉孔及椎体静脉解剖在椎体成形术中的意义[J]. 中国临床解剖学杂志, 2015, 33(6): 646-650. DOI: 10.13418/j.issn.1001-165x.2015.06.007.
[11]	Yeom JS, Kim WJ, Choy WS, et al. Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures[J]. J Bone Joint Surg Br, 2003, 85(1): 83-89. DOI: 10.1302/0301-620x.85b1.13026.
[12]	Wang C, Fan S, Liu J, et al. Basivertebral foramen could be connected with intravertebral cleft: a potential risk factor of cement leakage in percutaneous kyphoplasty[J]. Spine J, 2014, 14(8): 1551-1558. DOI: 10.1016/j.spinee.2013.09.025.
[13]	崔利宾, 唐本强, 王彦辉, 等. 年龄≥80岁骨质疏松性椎体压缩骨折患者经皮椎体成形术骨水泥渗漏的危险因素分析[J]. 中国脊柱脊髓杂志, 2020, 30(6): 530-538. DOI: 10.3969/j.issn.1004-406X.2020.06.08.
[14]	Li S, Wang C, Shan Z, et al. Trabecular microstructure and damage affect cement leakage from the basivertebral foramen during vertebral augmentation[J]. Spine, 2017, 42(16): E939-E948. DOI: 10.1097/BRS.0000000000002073.
[15]	赵兴, 赵凤东, 方向前, 等. 胸腰段椎体椎基静脉孔的 CT 影像学特征及其意义[J]. 中华骨科杂志, 2012, 32(1): 58-64. DOI: 10.3760/cma.j.issn.0253-2352.2012.01.010.
[16]	松尾博由. 腰椎部前内椎骨静脈の経年変化とVenogram所見[J]. 日本医科大学杂志,1985, 52(6): 633-641. DOI: 10.1272/jnms1923. 52. 633.
[17]	张旭阳, 李生鋆, 虞天明, 等. 胸腰椎爆裂性骨折椎体后上缘骨折块与椎基静脉孔的相关性[J]. 中华骨科杂志, 2017, 37(19): 1223-1230. DOI: 10.3760/cma.j.issn.0253-2352.2017.19.006.