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目的探讨代谢性及内分泌性骨病椎体骨密度变化的影像学表现及夹心椎椎体骨小梁区域性分布的特征。方法选取在影像学上椎体骨密度异常者36例,其中具夹心椎者12例行腰椎CT扫描。32例健康志愿者亦行腰椎CT扫描,对2组椎体不同部位骨量进行比较分析。22例行双能X线吸收测量仪(dual energy X-ray absorptiometry,DXA)检查,1例行骨组织形态计量学检查。结果骨密度异常包括骨密度减低和骨密度增高。骨密度增高分弥漫性及夹心椎2种。夹心椎组椎体上、中、下层的CT值分别为(259.94±18.08)、(182.96±34.85)、(270.34±19.40)HU,对照组椎体上、中、下层CT值分别为(191.08±30.35)、(190.50±20.53)、(201.12±30.72)HU,夹心椎组椎体上层和下层CT值均大于对照组。夹心椎组椎体上层和下层区组间CT值差异无统计学意义(F值分别为0.457、0.462,P值均>0.05),中层区组间CT值差异有统计学意义(F=4.539,P<0.05)。夹心椎患者骨矿密度(BMD)测值表现多样,骨量增多、正常和减少均可见。结论(1)夹心椎定量CT测量椎体上层和下层更有意义,夹心椎宜视为评估病情变化的影像学指标之一。(2)X线片显示骨软化变形者的骨密度增高并不一定代表骨量增多,其中尚含有正常骨量甚至是骨量减低者。以DXA测量椎体BMD值来区分真性骨硬化和硬化样骨软化是可取的。
Objective To investigate the imaging findings of the changes of vertebral bone mineral density (BMD) in metabolic and endocrinal osteoporosis and the regional distribution characteristics of trabecular bone in the vertebral body. Methods Thirty-six patients with abnormal vertebral bone densities in imaging were selected, of whom 12 with lumbar vertebrae CT scan. Thirty-two healthy volunteers underwent lumbar CT scan. The bone mass of two groups of vertebral bodies were compared and analyzed. 22 routine dual energy X-ray absorptiometry (dual energy X-ray absorptiometry, DXA) examination, 1 case of bone histomorphometry. Results Abnormal BMD included decreased BMD and increased BMD. Bone density increased diffuse and diffuse vertebra two kinds. The CT values of the upper, middle and lower vertebral bodies in the intervening vertebral group were (259.94 ± 18.08), (182.96 ± 34.85) and (270.34 ± 19.40) HU, respectively. The CT values of the upper, middle and inferior laminae of the control group were (191.08 ± 30.35), (190.50 ± 20.53) and (201.12 ± 30.72) HU, respectively. The CT values of the upper and lower vertebral bodies in the intervertebral disc group were all higher than those in the control group. There was no significant difference in CT value between the upper and lower vertebral bodies in the intervertebral disc group (F = 0.457,0.462, P> 0.05), and there was significant difference in CT value between the intermedia group (F = 4.539, P <0.05). Bone spine in patients with bone mineral density (BMD) measured performance varied, increased bone mass, both normal and reduced visible. Conclusions (1) It is more meaningful to measure the upper and lower vertebral vertebral body by quantitative myocardial CT. Sandwich vertebra should be considered as one of the imaging indexes to assess the changes of the disease. (2) X-ray film showed that bone densification increased bone mineral density does not necessarily represent an increase in bone mass, which still contains normal bone mass or even reduce the amount of bone. It is advisable to distinguish true and sclerosing osteomalacia by measuring vertebral BMD values with DXA.