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| 退变性腰椎侧凸的骨密度评估：CT HU值比DXA T值更准确 |
| Determining the bone mineral density in patients with degenerative lumbar scoliosis: CT Hounsfield unit values outperform DXA T-score |
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| DOI：10.3969/j.issn.1006-7108.2025.12.007 |
| 中文关键词: 骨密度 骨质疏松 退变性腰椎侧凸 亨氏单位 |
| 英文关键词:bone mineral density osteoporosis degenerative lumbar scoliosis hounsfieldunit |
| 基金项目:江苏省科技计划专项资金重点研发计划社会发展项目（BE2023658）；江苏省333高层次人才培养工程[（2022）3-1-128]；江苏省医学创新中心项目（CXZX202214） |
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| 中文摘要: |
| 目的 比较双能X射线吸收法T值和CT HU值在评估退变性腰椎侧凸患者骨密度中的作用。方法 回顾性分析2017年2月至2023年4月在南京鼓楼医院接受手术治疗的退变性腰椎侧凸（degenerative lumbar scoliosis，DLS）、腰椎椎管狭窄和腰椎间盘突出患者的临床及影像学资料，共337例纳入本研究，包括186例DLS组患者、100例腰椎椎管狭窄的对照A组患者和51例腰椎间盘突出的对照B组患者。根据Cobb角将DLS组患者分为轻度侧凸组、中度侧凸组和重度侧凸组。在对照A组采用受试者工作特征曲线得出HU值诊断骨量减少和骨质疏松的阈值，并应用于DLS组患者骨密度的诊断。比较DLS组与两对照组患者的一般资料，T值和HU值。对HU值和L1-L4 T值进行Pearson相关性分析。结果 DLS组与对照A组患者的年龄、性别、BMI及L1-L4 T值的差异均无统计学意义（P＞0.05）。DLS组的HU值和最低髋部T值均显著低于对照A组。对照B组患者的年龄、L1-L4 T值均显著低于DLS组，而HU值则显著高于DLS组。DLS组内，中度和重度侧凸组的HU值均显著低于轻度侧凸组（P＜0.05），而3个亚组的L1-L4 T值的差异无统计学意义；L1-L4 T值与HU值呈正相关，且轻度侧凸组的相关系数高于中度和重度侧凸组。根据HU值的诊断阈值，重度侧凸组骨质疏松的假阴性率明显高于中度和轻度侧凸组（54.9% vs.33.3% & 14.0%）。结论 对于DLS患者，特别在严重侧凸的患者中，DXA测量的腰椎T值偏高，导致诊断骨质疏松的假阴性率增加。HU值可以作为DXA的替代方法以提供更准确的骨密度评估。 |
| 英文摘要: |
| Objective To compare the performance of T-score and HU valuesinevaluatingbone mineral density for patients with degenerative lumbar scoliosis(DLS). Methods A total of 320 patients who underwent surgery from February 2017 to April 2023 in Nanjing Drum Tower Hospital was retrospectively reviewed, including 186 patients with DLS, 100 patients with lumbar spinal stenosis as control group A and 51 patients with lumbar disc herniation as control group B. Patientswere categorized into three subgroups based on the Cobb angle in DLS group. HU thresholds for osteopenia and osteoporosis were obtained by Receiver OperatingCharacteristic (ROC) analysis in control group, and then applied to diagnose osteopenia and osteoporosis in DLS group. The demographics, T-scoreandHUvalueswere compared between DLS and two control groups. Pearson correlation analysis was performed between HU valuesand T-score(L1-4). Results Demographicsand T-score (L1-4) showed no significant differencesbetween DLS and control group A. DLS patients had significantly lower lowest Hips T-score and HU values than control group A. DLS patients had significantly higher age and T-score(L1-4) than control group B, while had lower HU values than control group B.HU values in bothmoderate and severe scoliosis subgroup was significantly lower than that in mildscoliosis subgroup (P<0.05). In the DLS group, T-score (L1-4) was positively correlatedwith HU values, and the correlation coefficients in mild scoliosis subgroup(r=0.712,P＜0.001) were higherthan those in moderate and severe scoliosis subgroup(r=0.666,P＜0.001;r=0.341,P＜0.001). According to the HU values,the incidence of undiagnosed osteoporosis in the severe scoliosis subgroup wassignificantly higher than that in the moderate and mild subgroup (54.9% vs.33.3% &14.0%). Conclusion Patients with DLS can present with aberrantly increased T-score evaluated by DXA,while HU values could provide accurate assessments of BMD,particularly in patients with severe scoliosis. |
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