MRI影像VBQ分数在腰椎内固定术术前骨量评估中的应用

刘德国; 徐天波; 张颉鸿; 吕骜; 郑宇翔; 侯振海; 卢一生

doi:10.16766/j.cnki.issn.1674-4152.003489

MRI影像VBQ分数在腰椎内固定术术前骨量评估中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003489

中国人民解放军联勤保障部队第九〇三医院骨科，浙江杭州 310004

基金项目:

浙江省医药卫生科技计划项目 2022KY1031

详细信息

通讯作者:
侯振海，E-mail：wuqizlll@163.com

中图分类号: R681.53 R687.43
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- 文章访问数: 44
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- 被引次数: 0
出版历程
- 收稿日期: 2023-11-05
- 网络出版日期: 2024-07-20

Preoperative assessment of bone mass in patients with lumbar internal fixation by MRI VBQ score

Department of Orthopaedics, the 903rd Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hangzhou, Zhejiang 310004, China

摘要

摘要: 目的探讨MRI影像椎体骨质量(VBQ)分数在腰椎内固定手术患者术前骨量评估中的价值, 为临床术前评估此类患者骨量提供依据。方法选取2019年2月-2022年8月于中国人民解放军联勤保障部队第九〇三医院进行腰椎内固定手术患者83例的临床资料, 根据最低值是否 < -1.0进行评估, 分为低密度组(T值< -1.0, 包括骨量减少及骨质疏松)51例, 正常组(T值≥-1.0)32例。入选者术前均进行双能X线骨密度检测仪(DEXA)及MRI检查。对比2组临床特征(年龄、性别、BMI)及影像学资料, 以Pearson相关性分析VBQ分数与各项DEXA的T值相关性, 绘制受试者工作特征(ROC)曲线了解VBQ分数对骨量减少预测价值。结果正常组与低密度组2组患者在年龄、BMI、性别、糖尿病史等临床特征中比较差异均无统计学意义(P>0.05);低密度组DEXA股骨颈T值、DEXA总体髋部T值均低于正常组, VBQ评分高于正常组(P < 0.05);VBQ分数与患者DEXA股骨颈T值、总体髋部T值均呈负相关关系(P < 0.05)。ROC曲线分析显示, VBQ分数预测骨量异常(骨量减少和骨质疏松) AUC面积为0.842(95%CI: 0.754~0.930), 敏感度与特异度分别为70.60%、68.80%。结论 VBQ分数可有效区分骨量正常与骨量减少者, 与患者DEXA的T评分存在相关性, 可为临床腰椎内固定手术患者术前骨量评估提供参考依据。
- 磁共振 /
- 椎体骨质量 /
- 腰椎内固定手术 /
- 术前骨量
Abstract: Objective To evaluate the value of MRI vertebral bone quality (VBQ) score in preoperative bone mass assessment of patients with lumbar internal fixation surgery provides a basis for clinical preoperative evaluation of bone mass in such patients. Methods We selected and evaluated clinical data from 83 patients who underwent lumbar internal fixation at the 903rd Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from February 2019 to August 2022.The patients were categorized into two groups based on whether the lowest value was less than-1.0:the low-density group (T value < -1.0), including cases with osteopenia and osteoporosis (51 cases), and the normal group (T value ≥-1.0, 32 cases).Prior to surgery, all patients underwent dual-energy X-ray absorptiometry (DEXA) and MRI.We compared the clinical characteristics (age, gender, BMI) and imaging data between the two groups.Pearson correlation was used to analyze the relationship between the VBQ score and various DEXA T value.Additionally, we constructed a receiver operating characteristic (ROC) curve to assess the predictive value of VBQ scores for osteopenia. Results There was no significant differences in age, BMI, gender, history of diabetes, and other clinical characteristics between the normal group and the low-density group (P>0.05).The low-density group exhibited lower DEXA femoral neck T values and DEXA overall hip T values compared to the normal group, while the VBQ score was higher in the low-density group (P < 0.05).A negative correlation was observed between the VBQ score and the DEXA femoral neck T value as well as the overall hip T value (P < 0.05).The ROC curve analysis showed that the VBQ score had an AUC area of 0.842(95%CI: 0.754-0.930) for predicting abnormal bone mass (osteopenia and osteoporosis), with a sensitivity of 70.60% and specificity of 68.80%. Conclusion The VBQ score demonstrates effective differentiation between patients with normal bone mass and those with osteopenia, while also exhibiting correlation with the DEXA T score of patients.This provides a valuable reference for preoperative bone mass assessment in patients undergoing clinical lumbar internal fixation.
- Magnetic resonance imaging /
- Vertebral bone mass /
- Lumbar internal fixation /
- Preoperative bone mass

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图 1 VBQ分数预测骨量减少的ROC曲线

注：A~E为术前MRI影像；F~H为术后MRI影像。

Figure 1. ROC curve for predicting bone mass reduction using VBQ scores

下载: 全尺寸图片幻灯片

图 2 腰椎内固定手术前后治疗对比

注:A~E为术前MRI影像;F~H为术后MRI影像。

Figure 2. Comparative analysis of pre- and postoperative treatments for lumbar spine internal fixation

下载: 全尺寸图片幻灯片

表 1 2组腰椎内固定手术患者临床资料比较

Table 1. Comparison of clinical data for two groups of patients undergoing lumbar spine internal fixation surgery

组别	例数	年龄 (x±s, 岁)	BMI(x±s)	性别 (男性/女性，例)	糖尿病史 (例)	吸烟史 (例)	高血压史 (例)	产期使用胆固醇类激素(例)
正常组	32	63.64±5.76	24.16±2.15	11/21	4	6	8	2
低密度组	51	65.88±8.10	23.88±2.81	12/39	11	15	18	5
统计量		1.361^a	0.481^a	1.154^b	1.092^b	1.182^b	0.968^b	0.321^b
P值		0.177	0.631	0.282	0.295	0.276	0.325	0.570
注：^a为t值，^b为χ²值。

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表 2 2组腰椎内固定手术患者影像学资料比较(x ±s)

Table 2. Comparison of radiological data in two groups of patients undergoing lumbar spine fixation surgery (x ±s)

组别	例数	DEXA股骨颈T值	DEXA总体髋部T值	VBQ评分 (分)
正常组	32	-0.41±0.14	0.11±0.15	2.28±0.33
低密度组	51	-2.21±0.36	-1.84±0.33	3.48±0.34
t值		26.982	24.636	15.826
P值		＜0.001	＜0.001	＜0.001

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表 3 VBQ分数与各项DEXA的T值相关性

Table 3. Correlation between VBQ scores and T-scores of various DEXA assessments

项目	VBQ分数
项目	r值	P值
DEXA股骨颈T评分	-0.719	＜0.001
DEXA总体髋部T评分	-0.588	＜0.001

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