골다공증성 척추 압박 골절의 전 척추 시상면 MRI에서 분석
Analysis of Osteoporotic Spinal Compression Fractures in Whole Spine Sagittal MR Images
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연구목적: 급성 골다공증성 척추 압박 골절에 대해 전 척추 MRI를 이용하여 급성 골절과 동반된 골절의 유형 및 인접성을 분석하고, 시상 수직축 (sagittal vertical axis, SVA), 신체 질량지수, 골밀도와의 관계를 비교 분석하고자 한다. 연구방법: 2007년 6월부터 2010년 12월까지 전 척추 시상면 MRI로 진단된 급성 압박 골절 환자 167명을 대상으로, 최초급성 골절로 진단된 환자 82명 (남/여 : 25/57)을 1군으로, 만성 골절이 동반된 79명 (남/여 : 16/63)을 2군으로, 경피적 척추성형술 후 골절이 발생한 환자 20명 (남/여 : 8/12)을 3군으로 분류하였다. 전 척추 MRI를 이용하여 급성 골절의 위치, 동반된 만성 골절 또는 척추체 성형술 부위의 인접성을 알아 보았고, 시상 수직축 (mm)을 측정하여 척추 골절이 없는 대조군(60세 미만 환자 31명)과 비교하였다. 전 환자의 신체 질량지수 (kg/m2)와 요추부 골밀도를 측정하여 세 군을 비교하였다. 결 과: 전 척추 시상면 MRI에서 1군에서는 요추 1번이 31개로 가장 많았으며, 2군은 22명에서 만성 골절과 3부위 이상 떨어진 부위에 급성 골절이 관찰되었고, 특히 경 · 흉추와 요추에 급 · 만성 골절이 떨어져 발생한 경우가 14명이었다. 3군은 만성 골절과 인접 분절 골절이 각각 14명, 11명 관찰되었다. 척추 골절이 없는 대조군에 비해 1, 2, 3군 모두 시상 수직축이 증가하였으며, 특히 만성 골절이 있으면서 급성 골절이 생긴 2군에서 시상 수직축의 차이가 컸다. 세 군을 비교했을 때, 1군보다 2군, 3군에서 골밀도가 유의하게 낮았지만, 신체 질량지수에서는 차이가 없었다. 결 론: 골다공증성 척추 압박 골절 환자에서 전 척추 시상면 MRI로 국소적 MRI로는 발견하지 못했을 동반 골절을14명의 환자에서 발견할 수 있었다. 또한 이 연구는 시상 수직축이 길어지면서 시상면 불균형을 초래하는 것, 그리고 신체질량지수보다 골밀도의 감소가 만성 골절이 있는 환자에서 재골절의 발생과 관련이 있을 것을 시사한다.
Abstract
Objectives: To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fracture using whole spine sagittal MRI (WS-MRI), and to know the relation of sagittal vertical axis (SVA), body mass index (BMI), and lumbar bone mineral density (BMD). Methods: From June 2007 to December 2010, 167 patients who had acute spinal compression fractures confirmed by WS-MRI divide in three groups. 82 patients (M/F : 25/57) who had acute fractures only were in group 1, 79 patients who had acute and old fractures were in group 2, and 20 patients who had acute fractures after vertebroplasy were in group 3. To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fractures which combined chronic fracture or vertebroplasty using the WS-MRI and compared with the control group who had no spinal fractures measured the SVA. In all groups, we measured BMI, and BMD. Results: In WS-MRI, 31 patients in group 1 had L1 which was the most common fracture site. Twenty two patients had chronic fractures and more than 3 remote levels at the acute fracture site in group 2 and especially among there 14 patients have each level in cervicothoracic and lumbar vertebrae. In group 3 had old fracture and adjacent fracture was 14 and 11 patients. Compared with the control group, all groups had increased SVA, especially in group 2 which has acute and chronic compression fractures. They have no significantly difference of BMI in each group, but group 2 and 3 had a significant lower BMD than group 1. Conclusion: Fourteen patients of coexisting fractures in acute osteoporotic spinal compression fractures with WS-MRI which could be missed in the conventional MRI. Additionally this study suggests that longer SVA causes sagittal imbalance, and BMD is more relative than BMI in refractures of chronic compression fracture patients. [Korean Journal of Bone Metabolism, 18(2): 111-117, 2011]
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