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1 341 pissn : , eissn : Original Article J Korean Orthop Assoc 2018; 53: 골다공증성흉요추부척추압박골절환자의초기자기공명영상소견과압박률진행의상관관계 황석하 서승표 우영균 전호승 정호원 성애병원정형외과 The Influence of Initial Magnetic Resonance Imaging Findings on the Compression Rate of Thoracolumbar Osteoporotic Vertebral Compression Fracture Seok-Ha Hwang, M.D., Seung-Pyo Suh, M.D., Young-Kyun Woo, M.D., Ho-Seung Jeon, M.D., and Ho-Won Jeong, M.D. Department of Orthopedic Surgery, Sung-Ae Hospital, Seoul, Korea Purpose: To investigate the influence of the size of low intensity zone (LIZ) (T1 image) on the vertebral body and the increase in the compression rate in patients with osteoporotic vertebral compression fracture. Materials and Methods: In a retrospective study, 187 patients (198 segments) who were followed-up for at least 3 months and diagnosed with thoracolumbar vertebral compression fracture between October 2011 and October 2016, and treated with conservative therapies, such as bed rest and thoraco-lumbar-sacral orthosis. We measured the size of the vertebral LIZ, and fractures on the upper and lower endplates were observed on the initial magnetic resonance imaging. We analyzed the correlation with the increase in compression rate at the last follow-up. Comparisons of the increase in the compression rate were analyzed through a correlation analysis. Results: The larger the size of the LIZ the greater the difference in the increase of the compression rate. The group with the initially LIZ (80%-100%) was significantly increased to 23.87%±17.90% (p=0.007). In case of fracture of upper and lower endplates, an increase in the compression rate was 19.39%±12.59% in the upper endplate fracture, which was significantly higher than that in the absence of endplate fracture (p=0.002). Conclusion: The larger the size of the LIZ (T1 image) and superior endplate fracture observed on the initial magnetic resonance imaging after fracture, the greater the increase in the compression rate. In particular, when the size of the LIZ is greater than 80%, the compression rate was significantly increased. Key words: osteoporosis, compression fracture, compression rate 서론 Received December 12, 2016 Revised February 27, 2017 Accepted October 31, 2017 Correspondence to: Seung-Pyo Suh, M.D. Department of Orthopedic Surgery, Sung-Ae Hospital, 22 Yeouidaebang-ro 53-gil, Yeongdeungpo-gu, Seoul 07354, Korea TEL: FAX: arcseo@hanmail.net ORCID: 골다공증으로인한척추압박골절은매년증가하는추세로골다공증으로인한고관절골절보다발생빈도가높다고보고되며현대사회에서많은의료기관이중요한문제로인식하고있는질환이다. 1-3) 많은환자들중에서증상이미미한경우가많으며대부분은염좌로간과하기쉽고보통 23%-33% 에서만심한요통을호소하여진단이늦어지는경우가있다. 2,4) 대부분의골다공증성 The Journal of the Korean Orthopaedic Association Volume 53 Number Copyright 2018 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

342 Seok-Ha Hwang, et al. 척추압박골절은보존적치료로좋은추시결과를보이나일부환자들의경우에서는적절한보존적치료에도불구하고압박률이진행되고이로인해척추후만변형이나우울증또는사망등의여러합병증이증가한다고보고되고있다. 2,3) 하지만환자에따라압박률이진행되는정도가많이다르기때문에이를예측하기는쉽지않다.

Sugita 등 5) 은단순방사선검사소견을 5가지유형으로분류하여각각의예후를평가하였으며전방추체의압박이있는유형에서압박률의증가와추체내진공틈새 (intravertebral vacuum cleft) 의발생이증가함을보고한바있으며, Eastell 등 6) 은척추골절의형태와정도로분류하였다. 하지만이러한연구들은초기단순방사선사진을토대로하였으며자기공명영상을이용하지는않았다.

2 342 Seok-Ha Hwang, et al. 척추압박골절은보존적치료로좋은추시결과를보이나일부환자들의경우에서는적절한보존적치료에도불구하고압박률이진행되고이로인해척추후만변형이나우울증또는사망등의여러합병증이증가한다고보고되고있다. 2,3) 하지만환자에따라압박률이진행되는정도가많이다르기때문에이를예측하기는쉽지않다. 이전연구에서도진행성골다공증성척추압박골절의예후를예측하기위해영상검사를통한연구가진행되었다. Sugita 등 5) 은단순방사선검사소견을 5가지유형으로분류하여각각의예후를평가하였으며전방추체의압박이있는유형에서압박률의증가와추체내진공틈새 (intravertebral vacuum cleft) 의발생이증가함을보고한바있으며, Eastell 등 6) 은척추골절의형태와정도로분류하였다. 하지만이러한연구들은초기단순방사선사진을토대로하였으며자기공명영상을이용하지는않았다. 국내논문가운데 Koh 등 7) 은자기공명영상소견을통해압박률의증가율에관한예후인자를연구한바있으나연구표본수가적고압박률이진행한환자군을대상으로역으로조사하였다. 이에저자들은흉요추부골다공증성척추압박골절환자에서많 Table 1. Distribution of the Fracture Level Level Number L1 69 L2 47 T11 22 T12 60 Total 198 은표본을토대로초기방사선적요인가운데최초자기공명영상상에서보이는추체의음영변화의크기및상, 하부종판의골절과압박률의진행과의상관관계에대해알아보고자하였다. 대상및방법 2011년 10월부터 2016년 10월까지본원에내원한흉요추부골다공증성척추압박골절환자중침상안정및흉요천추보조기착용등의보존적요법으로치료한환자중최소 3개월이상추시가가능하였던환자를대상으로하였으며평균 4.3개월간 (3-6개월) 추시가능했던총 187명, 198분절을대상으로하였다. 가벼운낙상이나외상으로축성압박력을입은환자중 McAfee 분류에따라압박골절이나안정성방출성골절환자를대상으로하였으며남, 여비는 1.0:5.2였고, 평균연령은 74.15±12.83세였으며평균골밀도는 T-score는 -3.54±0.85였다. 환자는모두 2주간절대침상안정후통증및방사선검사를추시하여흉요천추보조기를착용하였으며그렇지않은군은대상에서제외하였다. 이차성골다공증환자와보존적치료도중시술및수술을받은경우는연구대상에서제외하였다. 제1 요추와제12 흉추가각각 69예, 60예로가장많았고그다음으로제2 요추가 47예, 제11 흉추가 22예로관찰되었다 (Table 1). 골밀도는이중에너지방사선흡수측정장치 (dual energy x-ray absorptiometry) 를이용하여측정하였다. 저음영구역 (low intensity zone, LIZ) 은골절시발생한골수음영이저하된부위를측정하였으며, 초기골절직후시행한자기공명영상 T1 강조영상시상면에서저신호강도를보이는영역의높이가가장큰지점과해당추체의가장높은높이와의비율로측정하였다 (Fig. 1). 계측은 2명이상의정형외과의사가시행하였 a A B c b Figure 1. Measurement methods for cavity on T1 weighted magnetic resonance imaging. Cavity=B/A 100 (%). Figure 2. Measurement methods for compression rate on simple x-ray. Compression rate=b/(a+c)/2 100 (%)

343 The Influence of Initial MRI Findings on the Thoracolumbar OVCF 고쿰멜병 (Kummell s disease) 에서보이는자기공명영상소견과는다름을정형외과전문의와함께영상의학과에서확인하였다.

LIZ의크기는 5단계로분류하였으며 (Grade I-V) 20% 간격으로구간을설정하여최종추시시추체전방높이의감소변화를관찰하여유의한차이가있는지알아보고자하였다 (Fig. 3).

Sagittal image of the T1 magnetic resonance imaging according to the size of the low intensity zone (LIZ). From grades 1 of the left side to 5. Table 2.

I (0% 19%) 7 8.44±4.73 0.000 Grade II 0.52820 1.000 Grade III 0.85997 1.000 Grade IV -4.45616 0.965 Grade V -15.43261 0.153 Group II (20% 39%) 31 7.91±1.71 Grade I -0.52820 1.000 Grade III 0.33177 1.

29259 0.000 Group IV (60% 79%) 58 12.90±15.94 Grade I 4.45616 0.965 Grade II 4.98436 0.673 Grade III 5.31613 0.447 Grade V -10.97646 0.007 Group V (80% 100%) 47 23.87±17.

3 343 The Influence of Initial MRI Findings on the Thoracolumbar OVCF 고쿰멜병 (Kummell s disease) 에서보이는자기공명영상소견과는다름을정형외과전문의와함께영상의학과에서확인하였다. 쿰멜병으로확인된경우및해당추체에골절의기왕력이있었던환자는배제하였고회전력이나전단력으로인한전종인대손상이관찰된경우도모두제외하였다. 압박률은골절된추체의전방높이와골절된추체에인접한상, 하추체의전방높이의평균비율로측정하였다 (Fig. 2). LIZ의크기는 5단계로분류하였으며 (Grade I-V) 20% 간격으로구간을설정하여최종추시시추체전방높이의감소변화를관찰하여유의한차이가있는지알아보고자하였다 (Fig. 3). LIZ의분포는 0%-19% 가 7예, 20%-39% 가 31예, 40%-59% 가 55예, 60%- 79% 가 58예, 80%-100% 가 47예로관찰되었다 (Table 2). 상, 하부종판골절과최종압박률의변화량과의상관관계를알아보기위해자기공명영상 T1 강조영상시상면상에서종판의피질골연속 Figure 3. Sagittal image of the T1 magnetic resonance imaging according to the size of the low intensity zone (LIZ). From grades 1 of the left side to 5. Table 2. Correlation between the Distribution of the Size of LIZ and the Change in the Compression Ratio between Groups LIZ* Number Average p-value Grade Mean difference p-value Group I (0% 19%) ± Grade II Grade III Grade IV Grade V Group II (20% 39%) ±1.71 Grade I Grade III Grade IV Grade V Group III (40% 59%) ±12.07 Grade I Grade II Grade IV Grade V Group IV (60% 79%) ±15.94 Grade I Grade II Grade III Grade V Group V (80% 100%) ±17.90 Grade I Grade II Grade III Grade IV Total ± *According to the size of the low intensity zone (LIZ). Average of change in compression ratio (Values are presented as mean±standard deviation.). p-value with the change of compression rate according to grade. p-value with each grade.

344 Seok-Ha Hwang, et al. A B C Figure 4. Magnetic resonance imaging T1 sagittal image. (A) Superior end plate disruption. (B) Inferior end plate disruption. (C) Both end plate disruptions. Table 3.

Location Number Average Grade I Grade II Grade III Grade IV Grade V Total (n) p-value None 134 10.43±14.73 4 (57.1) 22 (71.0) 35 (63.6) 38 (65.5) 35 (74.5) 134 - Superior end plate 39 19.39±12.

$85 7 31 55 58 47 198 - *Between having no end plate fracture and having an upper end plate fracture as well as between having a lower end plate fracture and having a both end plate fractures.$

4 344 Seok-Ha Hwang, et al. A B C Figure 4. Magnetic resonance imaging T1 sagittal image. (A) Superior end plate disruption. (B) Inferior end plate disruption. (C) Both end plate disruptions. Table 3. Correlation between the Distribution of the Location of End Plate Fractures and the Compression Ratio as well as the Correlation between the Degree and Location of the End Plate Fractures* LIZ Location Number Average Grade I Grade II Grade III Grade IV Grade V Total (n) p-value None ± (57.1) 22 (71.0) 35 (63.6) 38 (65.5) 35 (74.5) Superior end plate ± (0) 5 (16.1) 12 (21.8) 14 (24.1) 8 (17.0) Inferior end plate ± (28.6) 3 (9.7) 5 (9.1) 4 (6.9) 3 (6.4) Both end plate ± (14.3) 1 (3.2) 3 (5.5) 2 (3.5) 1 (2.1) Total ± *Between having no end plate fracture and having an upper end plate fracture as well as between having a lower end plate fracture and having a both end plate fractures. Average of change in compression ratio (Values are presented as mean±standard deviation.). According to the size of the low intensity zone (LIZ); Values are presented as number (%). Table 4. Bone Mineral Distribution and the Correlation between the BMD and the Change of the Compression Rate BMD (g/cm 2 ) Number Average* p-value ± ± ± ±18.17 Total ±15.85 *Average of change in compression ratio (Values are presented as mean±standard deviation.). BMD, bone mineral density. 성이중단되어골절된경우를분류하였으며 (Fig. 4), 상부종판이골절된경우가 39예, 하부종판이골절된경우가 17예, 상, 하부종판이모두골절된경우가 8예관찰되었다 (Table 3). 골밀도에따른압박률의증가량을알아보기위해 T-score를 , , , 로구간을설정하였으며각각 111예, 56예, 21예, 10예로나타났다 (Table 4). 성별에따른차이분석은독립 T 검정을사용하였으며, 평균연령및평균골밀도, 압박률의변화량의 평균을분석하기위해일원배치분산분석을사용하였다. 각구역의상관관계및상, 하부종판의골절에따른압박률의변화량과의상관관계는 Pearson correlation 검정을사용하여분석하였다. 본연구는본원연구윤리위원회의승인을얻고진행하였다 (SA ). 결과 1. 저음영구역의크기에따른압박률의변화량최종전방압박률은평균 13.08%±15.84% 진행하였으며, 압박률의증가량을그래프로관찰하였을때초기 LIZ의크기에따라압박률이통계적으로유의하게증가하였다 (p=0.000) (Table 2, Fig. 5). 최종추시시평균전방압박률은 Grade I에서 8.44%±4.73%, Grade II에서 7.91%±11.71%, Grade III에서 7.58%±12.07%, Grade IV 에서 12.90%±15.94%, Grade V에서 23.87%±17.90% 의압박률의증가율을보였다 (Table 2). 압박률의증가량은 Grade V에서통계적으로유의하게증가하였다 (p=0.007) (Table 2).

5 345 The Influence of Initial MRI Findings on the Thoracolumbar OVCF Change in compression rate Grade Figure 5. Tendency to increase the around of change in compression rate depending on the size of the initial low intensity zone size. Table 5. Correlation between Age, Gender, and Change of the Compression Rate Variable Number Average* p-value Age (yr) s ± s ± s ± s ±24.02 Total ±15.85 Gender Female ±11.64 Male ±14.47 *Average of change in compression ratio (Values are presented as mean±standard deviation.). 2. 상, 하종판골절에따른압박률의변화량상, 하부종판의골절이없는경우최종전방압박률은평균 10.43%±14.73% 진행하였으며상부종판의골절이있는경우 19.39%±12.59%, 하부종판의골절이있는경우 16.52%±25.17%, 상, 하부종판의골절이모두있는경우 19.64%±14.13% 로압박률의변화가관찰되었다. 상관관계를분석하였을때상부종판골절이있는군이없는군보다압박률의변화량이유의하게증가하였다 (p=0.002) (Table 3). 하부종판골절및상, 하부골판모두골절이있는경우최종전방압박률의변화량이골절이없는경우에비해증가하였으나통계적인유의성은없었다 (p=0.127, p=0.104) (Table 3). 3. 골밀도에따른압박률의변화골밀도를 -1 단위로 , , , 의 4개구간을나누어관찰하였으며 인구간에서압박률의증가량이 17.33%±19.69% 로가장큰변화율을보였지만통계적인유의성을확인하였을때 p=0.533으로통계적인유의성은없는것으로나타났다 (Table 4). 위의모든통계에서인구통계적특성은각각의군에서성별이나연령별로유의한차이가없었다 (p=0.372, p=0.308) (Table 5). 고찰 골다공증은현재가장흔한대사성골질환가운데하나로그로인한척추압박골절이매년 7천만명이상발생한다고보고되었다. 4,8) 압박골절은척추골절중가장흔한형태이며보통굴곡력에의한척추체의급성압박이기전으로설명되나골다공증이동반된고령의환자에서는가벼운외상이나특별한외상없이도발생할수있다고보고되고있다. 8) 대부분의환자에서통증과척추의 후굴변형이발생하며이로인한호흡곤란, 불면등을유발할수있다. 고령의환자에서심할경우에는사망에이를수있으며, 육체적활동의제한과심신의허탈로인해일상생활에제한이오고우울증이동반될수있다. 2,4,8,9) 따라서고령화사회에서골다공증성압박골절은노년기환자들의삶의질을결정하는중요질환이되었으며질환에이환이된시점부터보다정확한평가를통해예후와치료의방향을결정하는것이중요해지고있으나현실적으로어려운실정이다. 이는골다공증성척추압박골절의보존적인치료에있어서침상안정과흉요천추보조기및조기보행등의다양한보존적인방법이있으나, 4) 적절한보존적치료에도불구하고환자마다다양한경과를지니며압박률도매우다양하게진행되기때문이다. 10,11) 이러한골다공증성척추압박골절시압박률의변화에영향을미치는인자에대한다양한연구가진행되었으며, Kim 등 12) 은일반적으로척추변형을일으키는요인으로골밀도가영향을미친다고보고하였고, Sohn 등 11) 은나이, 성별등이예후에미치는요인을연구하였으나유의할만한결과를얻지못했다고보고하였다. 또한국내에서도 Koh와 Kim은 13) 나이, 성별, 골절부위, 골절유형, 수상기전에따라압박률변화추이를분석하였으며이중여성에서압박률이유의하게증가하는것을보고하였다. Koh 등 7) 이자기공명영상검사를통해관찰되는골수음영소실된공간이압박률의증가량에영향을미친다고보고한바있으나표본의수가적었다. Jun 등 14) 은 McAfee 분류에서안정성방출성골절을입은환자의초기자기공명영상에서관찰된소견들중 LIZ의크기, 상, 하종판의골절과관련한예후에대해평가하였으며상부종판골절이있을경우및 LIZ의크기에따라최종추체압박률의변화량과통계적유의성이있음을 (p<0.001) 보고한바있으며이는추체에가해진외력으로인해발생한상부종판의골절이추간판의변형과피질골의소실로인한것으로보고하였다. 또한

6 346 Seok-Ha Hwang, et al. 가벼운외상으로인한순수한축성압박력을입은골다공증성척추압박골절환자를대상으로한본논문의결과와유사하였다. 본논문의저자들은진행성골다공증성척추압박골절환자에서자기공명영상을통한초기평가를통해추후추체의압박이진행되는정도와그유의성에대하여연구하였으며, 그결과자기공명영상의 T1 영상에서보이는 LIZ의크기가클수록선형으로압박률의변화량이유의하게증가하였으며, 또한 80% 이상인구간에서더욱유의하게증가하는것을알수있었고 (p=0.007) 상부종판골절이동반된경우그렇지않은경우보다최종추체압박률의변화량이증가하는것을알수있었다. LIZ의크기가클수록압박률의변화량이커지는이유로는해부학적으로추체의혈행은분절동맥에의해서이루어지는데후방추체는분절동맥의후방가지가위, 아래에서혈행을공급하는반면, 전방추체는분절동맥의하나의전방가지에의해서혈액을공급받기때문에손상받았을경우추체의허혈성손상이일어나기쉽다 ) 따라서전방추체에존재하는 LIZ가크기가클수록추체내구조의손상및파괴가크고이로인한분절동맥의손상이존재할가능성이크며이는결국추체의허혈성손상이발생할가능성이커질것으로생각된다. 척추체는겉으로 mm 의피질골껍질에의해둘러싸여있는해면골로구성되어있으며수평면에서는등방성을띠나이외의면에서는이방성을띠는특이한구조물로알려져있다. 이는추체의용적밀도를결정하게되며추체강도에매우중요한요인으로알려져있다. 18) 몇몇저자들은추체의강도는총골소주의비율에영향을받는다고보고한바있으며, 18,19) 정상적으로 20-40세의연령군은 1,000-1,200 kg을견딜수있으나골다공증환자에서는수평골소주의간격이넓고얇아져골기질의감소등으로골의강도가현저히저하되어 kg의하중을견디는것으로보고된바있다. 본논문에서상부종판의골절이있는경우결과적으로추체압박률의변화량이증가하였는데이는상부종판에강한외력이가해지면서골소주가소실되었을것으로생각되며이는과거 Jun 등 14) 이외력이가해지며변형된추체에서조직의재분배와추간판의점차적인상부종판으로의이행은추체의후굴변형에중요한인자로보고된바있다. 이러한골소주의정량적인보고외에도, D Ippolito 등 20) 은골다공증환자에서골기원세포가감소하여골모세포의형성이저하되어있고, 이로인하여치유능력이많이저하된다고보고하였다. 특히골다공증에쉽게이환이되는척추체의경우이러한현상이더두드러질수있다고보고하였다. 결국골다공증환자에서는감소된골기질로인한추체강도의약화및감소된골모세포로인한골기질의원활한재형성의부재로인하여손상되었을시적절한재생이힘들고, 구조적으로많이손상된추체일수록그만큼복구되기어려울것으로생각되었으며, 이는저자들이초기자기공명영상에서관찰했던골수및 종판의손상과압박률의상관관계에대한연구한결과와같은결론이었다. 1978년 Maldague 등 21) 이허혈성척추골절환자에서단순방사선영상상에관찰되는횡형의방사선투과성음영의영상에대한보고를처음으로하였으며이를 intravertebral vacuum cleft라명시하였다. Sarli 등 22) 은 T1 자기공명영상상을통해서이러한모양이추체내에저강도신호로관찰되며 T2 강조영상에서고강도신호와함께액체저류음영이관찰된다고보고한바있다. 이러한방사선투과성음영은추체의허혈로인한골괴사에의해발생하며외상이나영양불균형, 신경혈관손상에의한것으로보고된다. 22,23) 저자들이자기공명영상에서관찰한 LIZ는수직압박력에의한척추체내의해면골이손상된공간으로, 자기공명영상 T1 강조영상에서횡형을띠고있었으며저신호강도는보이는등, intravertebral vacuum cleft의자기공명영상에서보이는 T2 강조영상에서의액체집적소견이보이지않았으며급성골절로의심되는고강도신호가관찰되어 intravertebral vacuum cleft와감별할수있었다. 저자들은골밀도가골다공증성척추압박골절환자에서예후에영향이있다는점을토대로미루어영상검사상에서발견되는골소주의소실이압박률의진행정도에영향을미치는요인이될수있다고생각하여본연구를진행하였으며, 초기 LIZ의크기가클수록압박률이통계적으로유의한수준으로증가함을확인할수있었다. 특히 LIZ의크기가 80% 이상인경우부터감소율이크게증가하였다. 이는골다공증성척추압박골절로내원한환자에서 LIZ의크기가 80% 이상이라면예후가안좋을것으로예상해볼수있다고생각된다. 또한하부종판이나상, 하종판골절이최종압박률의변화량에미치는영향이통계적으로유의성은없는것으로확인되었지만이는본논문에서표본의수가적었으며, 하부및상, 하종판골절의경우후방인대복합체의손상이동반된불안정형방출성골절의가능성이높아조기에수술적치료를받아결과에영향을미쳤을것으로생각된다. 본연구의제한점은후향적연구이다보니모든환자들이동일한조건에서연구가진행되지않았다는점이다. 최대한동일한조건에서결과를평가하고자하였으나환자의침상안정기간및보조기착용기간등이각각달랐을것이다. Pfeifer 등 24) 에의하면골다공증성척추압박골절의경우최소 6개월간보조기를착용할것을권하였고 Koh와 Park 25) 의연구에의하면 8주까지보조기를철저히착용할것을권하는것으로보아보조기착용기간이압박률의진행에밀접한영향을미치는것으로생각되며본연구에수집한환자데이터의경우제각각다른보조기착용기간이영향을미쳤을것으로생각된다. 두번째로자기공명영상검사에서관찰되는 LIZ의크기측정이시상면에서이루어졌다는것이다. 이는 LIZ, 즉골소주의소실을평가한방법이실제로추체전체에서차지하는비율이아니기때문에전체소실량과차이가있

7 347 The Influence of Initial MRI Findings on the Thoracolumbar OVCF 을것이며이는본논문의결과에영향을미쳤을것으로예상된다. 따라서향후연구에서는삼차원적으로 LIZ의부피를구하여비교를한다면보다유의한결과가나올수도있다고생각한다. 또한 LIZ이차치하는영역을구분하여전, 후방에차지하는크기에따라척추의혈행이미치는영향이달라질것이므로압박률의진행에도차이가있을것으로예상된다. 결론 흉요추부골다공증성척추압박골절에서초기관찰되는 LIZ의크기에따른임상적최종추시결과는 LIZ의크기가클수록압박률의증가율이점차증가하였으며 80% 이상인군에서증가율이가장컸다. 따라서초기에가벼운외상으로순수한축성압박력을입은골다공증성척추압박골절환자일지라도초기에관찰되는 LIZ의크기가클수록압박이진행될것을예상할수있으며 80% 이상인경우와상부종판골절이동반된경우에는압박률이크게진행될가능성이높아침상안정및엄격한흉요천추보조기의착용, 통증조절, 골다공증관리등의철저한보존적가료를요할것으로생각되는바이다. CONFLICTS OF INTEREST The authors have nothing to disclose. REFERENCES 1. Melton LJ 3rd. Epidemiology of spinal osteoporosis. Spine (Phila Pa 1976). 1997;22:2S-11S. 2. Francis RM, Aspray TJ, Hide G, Sutcliffe AM, Wilkinson P. Back pain in osteoporotic vertebral fractures. Osteoporos Int. 2008;19: Ehsanbakhsh AR, Akhbari H, Iraee MB, et al. The prevalence of undetected vertebral fracture in patients with back pain by dual-energy X-ray absorptiometry (DXA) of the lateral thoracic and lumbar spine. Asian Spine J. 2011;5: Prather H, Watson JO, Gilula LA. Nonoperative management of osteoporotic vertebral compression fractures. Injury. 2007;38 Suppl 3:S Sugita M, Watanabe N, Mikami Y, Hase H, Kubo T. Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech. 2005;18: Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd. Classification of vertebral fractures. J Bone Miner Res. 1991;6: Koh YD, Yoon JS, Hwang JY, Park HS. The relationship between progression of body collapse and MRI findings in osteoporotic stable thoracolumbar fractures. J Korean Fract Soc. 2008;21: Lau E, Ong K, Kurtz S, Schmier J, Edidin A. Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. J Bone Joint Surg Am. 2008;90: Bengnér U, Johnell O, Redlund-Johnell I. Changes in incidence and prevalence of vertebral fractures during 30 years. Calcif Tissue Int. 1988;42: Park JH, Kang KC, Shin DE, Koh YG, Son JS, Kim BH. Preventive effects of conservative treatment with short-term teriparatide on the progression of vertebral body collapse after osteoporotic vertebral compression fracture. Osteoporos Int. 2014;25: Sohn JM, Kim KW, Ha KY, Ha NK, Kim YH, Kim JH. Risk factors for the progressive osteoporotic spinal fracture. J Korean Soc Spine Surg. 2009;16: Kim WJ, Kang JW, Park KY, Park JG, Jung SH, Choy WS. Clinical outcome of conservative treatment for osteoporotic compression fractures in thoracolumbar junction. J Korean Soc Spine Surg. 2006;13: Koh YD, Kim JO. Risk factors in progression of deformity in compression fracture of thoracolumbar junction. J Korean Fract Soc. 1999;12: Jun DS, Shin WJ, An BK, Paik JW, Park MH. The relationship between the progression of kyphosis in stable thoracolumbar fractures and magnetic resonance imaging findings. Asian Spine J. 2015;9: Theodorou DJ. The intravertebral vacuum cleft sign. Radiology. 2001;221: Ratcliffe JF. The arterial anatomy of the adult human lumbar vertebral body: a microarteriographic study. J Anat. 1980;131: Bhalla S, Reinus WR. The linear intravertebral vacuum: a sign of benign vertebral collapse. AJR Am J Roentgenol. 1998;170: Mosekilde L. Normal age-related changes in bone mass, structure, and strength: consequences of the remodelling process. Dan Med Bull. 1993;40: Mosekilde L. The effect of modelling and remodelling on human vertebral body architecture. Technol Health Care. 1998;6:

8 348 Seok-Ha Hwang, et al. 20. D'Ippolito G, Schiller PC, Ricordi C, Roos BA, Howard GA. Age-related osteogenic potential of mesenchymal stromal stem cells from human vertebral bone marrow. J Bone Miner Res. 1999;14: Maldague BE, Noel HM, Malghem JJ. The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology. 1978;129: Sarli M, Pérez Manghi FC, Gallo R, Zanchetta JR. The vacuum cleft sign: an uncommon radiological sign. Osteoporos Int. 2005;16: Wu AM, Chi YL, Ni WF. Vertebral compression fracture with intravertebral vacuum cleft sign: pathogenesis, image, and surgical intervention. Asian Spine J. 2013;7: Pfeifer M, Begerow B, Minne HW. Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: a randomized trial. Am J Phys Med Rehabil. 2004;83: Koh YD, Park JS. Progression of compression and related factors in conservative management of osteoporotic vertebral compression fractures. J Korean Fract Soc. 2015;28:132-8.

9 349 pissn : , eissn : Original Article J Korean Orthop Assoc 2018; 53: 골다공증성흉요추부척추압박골절환자의초기자기공명영상소견과압박률진행의상관관계 황석하 서승표 우영균 전호승 정호원 성애병원정형외과 목적 : 흉요추부골다공증성척추압박골절의환자에서초기시행한자기공명영상 T1 영상에서관찰되는척추체내의저음영구역의 크기와압박률의증가량간의상관관계에대해알아보고자하였다. 대상및방법 : 2011 년 10 월부터 2016 년 10 월까지흉요추부척추압박골절로진단받고침상안정및흉요천추보조기착용등의보존 적요법으로치료한환자중최소 3개월간추시가능했던총 187명의환자, 198분절을대상으로하여후향적연구를진행하였다. 초기자기공명영상에서관찰되는척추체저음영구역의크기와상부종판및하부종판의골절여부를측정하였으며, 최종추시시의압박률증가량과의상관관계에대해분석하였다. 압박률증가량의비교는상관분석을통해분석하였다. 결과 : 골절직후관찰되는저음영구역의크기가클수록압박률의증가량의차이가유의하게증가하였으며초기저음영구역의크기가 80%-100% 인집단에서압박률의증가량이평균 23.87%±17.90% 로유의하게증가하는것으로나타났다 (p=0.007). 상, 하종판의골절이동반된경우상부종판골절이있는경우가없는경우에비해압박률의증가량이평균 19.39%±12.59% 로유의하게증가하는것으로나타났다 (p=0.002). 결론 : 골절직후자기공명영상 T1영상에서관찰되는저음영구역의크기가클수록상부종판의골절이있는경우압박률의증가량이커짐을알수있었으며, 특히저음영구역의크기가추체대비 80% 이상큰경우유의하게증가하는것을알수있었다. 색인단어 : 골다공증, 압박골절, 압박률 접수일 2016 년 12 월 12 일수정일 2017 년 2 월 27 일게재확정일 2017 년 10 월 31 일책임저자서승표 07354, 서울시영등포구여의대방로 53 길 22, 성애병원정형외과 TEL , FAX , arcseo@hanmail.net, ORCID 대한정형외과학회지 : 제 53권제 4호 2018 Copyright 2018 by The Korean Orthopaedic Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Lumbar spine

Lumbar spine CT 32 111 DOI : 10.3831/KPI.2010.13.2.111 Lumbar Spine CT 32 Received : 10. 05. 23 Revised : 10. 06. 04 Accepted : 10. 06. 11 Key Words: Disc herniation, CT scan, Clinical analysis The Clinical