JPS62261344A - Method for judging deformation of vertebral body - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION <Industrial Application Field> The present invention relates to a method for determining vertebral body deformity. More specifically, the present invention relates to a method for classifying deformation of a vertebral body, which is one of the bones forming the column. Determining the presence or absence of vertebral body deformation associated with osteoporosis and the classification of the deformity is very important for understanding the degree of progression of osteoporosis and ensuring the effectiveness of treatment.

<Prior Art> Conventionally, the presence or absence of deformation of the vertebral body, which is one of the bones that form the pillars, has been determined by a doctor visually from side xwi images of the thoracic and lumbar vertebrae.

For example, compared to fractures of so-called long bones such as the femur at 9 o'clock and the radius at 1 ulna, vertebral body deformity is wedge-shaped.

It is difficult to diagnose because it is a compression fracture, depressed fracture, etc.
Is it possible to avoid individual differences in judgment, and even if we try to track changes over time to confirm treatment effects? 1fll
Because the deformation was not quantified, it was not always possible to accurately determine the progress of deformation.

In addition, the third t, the ratio of the median length (at) of the vertebra to the anterior υ length (dl)
a/d) & index of bone atrophy degree (LumbarSpi)
ne 5core) or by looking at changes in the vertical and horizontal trabeculae of the 311th vertebrae to determine the index of bone degeneration (Jikei Grand Classification N degree)
It has been reported that vertebral body fractures are determined by measuring the median length (a), anterior edge length (d), and posterior line length (dl) of the vertebral body.・England Journal of Medicine (The New E.
ngland Journal of Medicine
e), vol 306.446 (February 25, 1982)], methods for classifying the types of vertebral body deformities have been known (・.

<Problems to be Solved by the Invention> As a result of intensive research into objective methods for vertebral body deformation, the present inventors have determined that the anterior edge, posterior edge,
Accurately measure the length of the central part, calculate the ratio of each part of the vertebral body, and objectively determine the presence or absence of vertebral deformity using criteria that combine the length and ratio of the vertebral body. Furthermore, the type of vertebral body deformation is determined using criteria that combine the length and ratio of the vertebral body, and the vertebral body deformation changes over time from changes in the deformation type and length of the vertebral body. The present invention was completed by discovering a scale that can also judge progress.

According to the present invention, from a lateral X-ray image of a vertebral body, the central part (a)
, measure the trailing edge length (cl and leading edge length + dl, and further e /
Find the ratios of d, a/e and a/d, and calculate these e + d He/dl E'/e and a
A method for determining vertebral body deformation is provided, which is characterized by determining the type of vertebral body deformation based on vertebral body deformation.

Conventionally, a doctor visually viewed the side X-ray image of the vertebral body to determine whether there was a vertebral body deformity, but the method of the present invention measures the length of each part of the vertebral body and uses the doctor's judgment as a reference. This is a method for objectively determining the presence or absence of vertebral body deformation and the classification of the deformation type.

The determination method of the present invention will be explained in more detail below.

(1) First, from a lateral X-ray of an undeformed vertebral body, the central part (a), posterior length (c), and anterior edge length (dl) are measured for each vertebral body, and the average value of C (τl, Average value of d (a).

Find the sequence lca standard deviation r).

The above measurements are the central part (a) and the posterior edge length (c) determined from the patient whose vertebral body deformity is to be determined.

This is to obtain a reference value that is used as a criterion for determining the leading edge length (d), etc.

The undeformed vertebral body to be measured should be a vertebral body of a person whose age is usually from 50 years or older to about 75 years old, taking into account the age of the patient whose vertebral body deformity is to be determined. is preferred. Furthermore, it is preferable to perform measurements separately for men and women, and it is desirable to measure approximately 50 or more vertebral bodies for each.

When taking a lateral X-ray image of a vertebral body, there are a total of 1,741 vertebral bodies; thoracic vertebrae from the 1st thoracic vertebrae to the 12th thoracic vertebrae, and lumbar vertebrae from the 1st thoracic vertebrae to the PH5 lumbar vertebrae, so for example, the 8th thoracic vertebrae It is advantageous to take the images separately into a lateral X-ray image centered on the lumbar vertebrae and a lateral X-ray image centered on the @3 lumbar vertebrae. In addition, in lateral ML X-ray images centered on the 8th thoracic vertebra, the 1st and 4th vertebrae cannot be accurately measured in most cases, and the 2nd and 3rd thoracic vertebrae are often unclear, but in these vertebral bodies, The degree of vertebral deformity is not large, so 4 (II) from the 4th or 5th thoracic vertebrae
It is sufficient if it can be determined.

The central part of the vertebral body (a), the posterior length (c), and the anterior edge length fdl are:
Specifically, it is as shown in FIG. To obtain these values, measure the central part (a), posterior edge length (c), and anterior edge length (d) of each vertebral body using a ruler, caliper, etc. from the lateral X-ray image of the vertebral body. However, by inputting points 1 to 606 shown in Fig. 1 into a computer through a digitizer, the central part (a) (J 4 ) r trailing edge length tel (5
-6), while measuring the leading edge length (d) (1-2),
It is also possible to measure the ratios of C/d, a/c, and a/d.For example, the length of each part of the vertebral body can be calculated using a television camera, etc., to memorize blackening and electric current, and use image processing to calculate the length of each part of the vertebral body. Automatic needle 01 may also be used.

(11) Next, from the lateral X-ray image of the vertebral body of the patient whose vertebral body deformity is to be determined, in the same manner as in (1), for each vertebral body, the central part (a), posterior edge length (c), I #1 measures the length (d) and then c/d + a/e + a/d
The ratio? Find the total J.

These measurements, etc. can be carried out in the same manner as in the case (1) above.

0++> Then & He Hd + e/d
+ Based on IL/e and a/d, vertebral body deformation can be determined, for example, as follows.

That is, prisoner I C/ d + e + d v a /
(+ If the snow a/d satisfies the following conditions, it can be determined as "no deformation" (type N).

1a) 0.70(c/d(1,401bl c≧
Tom-2 dead, d≧(T-1, at least one of 52 is satisfied (c) a/c (0,80, a/d<0.80, at least one of the following is satisfied) The first condition (a
), the ratio C/d between the length of the front line and the length of the front line is 0.70.
and 1.40. As described later 1c
When e/d is 1.40 or more, the anterior edge becomes a deformed cuneiform vertebrae, and when c/d is 0.70 or less,
In reality, this is because, although very rare, the posterior M Its becomes a deformed reverse cuneiform vertebrae.

Next, as t42 condition (b), trailing edge length C9 leading edge length d
At least one of them was determined in (1). The average values of the posterior edge length C and anterior length d of the undeformed vertebral body are τ and a, respectively.
Then, it is necessary that i-2> and a-1,56- be larger. In a typical healthy vertebral body, a, c, and d are all large, a≧i-2>, c≧: -2t>.

d≧a -1,5-, but the vertebral body is slightly compressed,
a (Even if 'h -217', C≧'e
If either one of the conditions -2F or d≧a -1,5> is satisfied, no obvious deformation of the vertebral body is recognized and it can be determined that there is "no deformation".

Third condition (as ej, at least one of a/c and a/d must be 0.80 or more. a/
e Ha/d both.

This is because if it is 0.80 or less, that is, if the median length a is particularly small compared to the trailing edge length C9 and the leading edge length dK, it will be determined that the vertebrae are fish vertebrae, as will be described later.

For the above reasons, when the above conditions (a), (b), and (c) are satisfied, it can be determined that there is no deformation.

The relationship between the conditions (a), (b), and (c) above or each condition described below and each type of vertebral body deformation described below including "no deformation" is shown in FIG.

(B), c/d f, c/d ≧1.40 f
), it can be determined that it is ``lCr1lj-like vertebrae'' (type vertebrae).

As shown in Figure 3, the cuneiform vertebrae are deformed at the front,
The front length (d) is significantly smaller than the trailing edge length (e). For example, when the front length becomes 3/4 of the trailing edge length (c/d=t, 3a), Although deformation of the radicular vertebral body is already recognized, it may not always be recognized as a clear cuneiform vertebra. On the other hand, when the anterior line length is 2/3 of the posterior edge length (a/d = 1.50), it is clearly recognized as a carotid vertebra, so a/d ≥ t, 40ik search vertebrae. This was used as the judgment criterion.

In addition to the so-called cuneiform vertebrae, Cuneiform vertebrae (Type I) also include compression fractures on the upper side, depressed upper edge fractures, compression fractures on the lower edge, and depressed lower edge fractures. It includes a modification in which the front length is shortened, and as described below (a (a-2a).

Even in vertebral bodies determined to be flat vertebrae with c(i-2>, d(J-1, 5>), the deformation of the anterior edge is particularly significant, and e/d≧1.
40, it can also be determined as cuneiform vertebrae.

K? ), c/d is determined to be "reverse cuneiform vertebrae" (type ■) when c/d≦0.70.

Inverted lamina, the anterior edge of the specimen vertebrae is deformed and the length of the posterior edge (c
) Compared to K, previous 1. In contrast to the fact that the head of the family (d) has become smaller, a deformation has occurred in the rear ikube.

Frontal length (dl) It is defined as a vertebral body whose posterior length (e) is smaller than K (see Figure 3), but in reality, such a vertebral body hardly exists.Fifth lumbar vertebra Now, as shown in Example 1, compared with the leading edge length (d) K, the trailing edge length (cl
is small, and the average value of C76 is 0.95, which is less than 1, but even when the trailing edge (c) becomes 3/4 of the leading edge length (dl (c/d=o, 7s) In some cases, it may not be clearly recognized as a reverse cuneiform vertebrae, and therefore, if e/d≦0.70, it can be determined as K, a reverse cuneiform vertebra (type ■).

■-cHdIf Hc/d satisfies the following conditions, it is determined that it is a "flat vertebrae" (type ■). -I can.

(al, c(ε-2's (bl, a<tr 1.5(>) (cl, o, 7o(c/d(1,4° 1st condition (a)
, the second condition <b) is e -2C when the posterior edge (c) and the anterior edge length (dl) are the average values of undeformed vertebral bodies as stones and J.
Both P and 'l are smaller than 1.5o-, that is, C
(: -2(>-, and d ('a-1,5ty-
A torn 6° flat vertebra is a vertebral body whose anterior edge, middle, and posterior parts are compressed relatively uniformly and deformed (see Figure 3). ).

The rear 4j length (c) is both smaller.

As shown in the average length of each part of the undeformed vertebral body in Example 1, even in the undeformed vertebral body, the central part (a) has The characteristics of flat vertebrae are that the anterior edge length (di) and the posterior edge (cl) are particularly small, with c-29 and a(a-1,
The 5F vertebral body is determined to be Ld flat vertebra (type ■).

In addition, C is -2ty- and d is -1,50-.
As shown in Example 1, ε〉a, so by setting such conditions, C and d become approximately equal values, and as a flat vertebra, it becomes ′- to satisfy the condition of The second condition tel is 0.70(c/d(1,40
It is. a (M -2cp-, e (i: -2cr
-+ d (Even in the case of c[-1,5o-, the deformation of the anterior edge is particularly significant, and if c/d≧1.40, it is determined to be a cuneiform vertebra, as described above, and the posterior edge The deformation of e
/d(0,70, this is because it is determined that the vertebrae are inverted proximal.

E:+-c/d+e+dta/c
If 1 a/d satisfies the following conditions, it can be determined to be "analogy" (type V).

(at 0, 70 (c / d (1, 40 (b
l satisfies at least one of e≧E-2cP-9d≧1-1.5- (cl a/a≦1), 80 and a/d
≦0.80 "Analogy" means that a depression fracture or compression fracture occurs in the central part, and the central part (at) is the anterior edge length (d), the posterior edge (e
) is a particularly small vertebral body (see Figure 3). Therefore, the so-called "
Among "no deformation", the center part fa+ is particularly small.

Compared to the leading edge length (d) and the trailing edge (c), the central part (a) is smaller, a/c (0.90 and a/d
(At 0.90, an analogous-like deformity is already recognized, but it may not necessarily be recognized as a clear fish vertebrae,
/ c (0,80 and a / c (0,80) can be used as a judgment criterion for analogy.

In analogy (type ■), in addition to the so-called analogy, there are compression fractures of the upper edge, depressed fractures of the upper edge, compression fractures of the lower edge, and depressed fractures of the lower edge, resulting in the central part becoming similar to the analogy. Including shortened transformations (・ro.

As mentioned above, we have described the criteria for determining ``no deformed vertebrae'', ``reverse lamina vertebrae'', ``flat 11ε'', and ``fish vertebrae''. Indicated.

In the above-mentioned f41 constant, preferably - for example, c
/ d cliff! ” Assuming that the upper limit is 1.4. Although the lower limit of 0.70 has been explained in reverse, these values can be arbitrarily selected from the range of 1.25 to 1.55, for example, for the upper limit. Preferably 1.33 to 1.50,
More preferably; it can be selected from the range of 1.40 to 1,450. The lower limit is usually 0.80 to 0.60.

Preferably, it can be arbitrarily selected from the range of 0.75 to 0.65.

As a criterion for a/c and a/d.

We chose 0.8 for "no transformation" and "analogy," but this value is usually 0.65 to 0.90.

Preferably 0.70 to 0.85, more preferably 0.
It can be arbitrarily selected from the range of 75 to 0.80.

Judgment criteria for C and d are “no deformity” and “cotton-flat vertebrae”
, in the -1 warehouse of "analogy";-2tp-.

J-2> was selected, but the criterion for C is 1 lightning strike c-
1.0'-~blind-2,5, preferably j 1.25
ch~i-2,25F, particularly preferably knee 1.5cp
-~c-2,0 IP range:,! You can choose to. The criteria for d are 1 normal, a-1.0- to go 2.5P.

Favorite L (ha, a-1, 25 to H-2, 25CP.

Particularly preferably, it can be arbitrarily selected from the range of 1-1.5 o- to "a-2, OP."

<Effects of the Invention> According to the evaluation method of the present invention, it is possible to objectively evaluate the type of vertebral body deformation, and it is also possible to determine changes in shape type and progression of vertebral body deformation over time. Can be done.

In addition, K is also very useful for checking the progress of bone diseases such as osteoporosis and confirming the therapeutic effect.

<Example> Example 1: Frontal length (d) and median length of each vertebral body from lateral X&1 images of thoracic vertebrae centered on the 8th, thoracic and 3rd lumbar vertebrae of a woman aged 50 to 75 years (a), length (c), vertebral body width (bl)
The measured values of + m g b, c T d and c
The average value 1xl of the calculated value of /d for each square body and the heading deviation <tS are as shown in Table 1.

Example 2 Median length (a) and width (b) of each vertebral body from a lateral X-ray image of the thoracolumbar vertebrae of a 70-year-old osteoporosis patient (female).

Trailing edge length (c), leading edge length (dl) It was measured c/d
, a/e.

Table 2 shows the results of a/d calculations to determine the presence or absence of deformation of each vertebral body and the type of change.

Note that the determination was made based on the criteria shown in FIG. The same applies to 5A Examples 3 and 4 below.

Example 3 The median length of the third lumbar vertebra (
Measure the vertebral body width (a), posterior edge length (c), and anterior length (dl), calculate c/d + a/c r a/d, and determine the presence or absence of deformity and the type of deformity. The results are shown in Table 3.

The second lumbar vertebrae changed from "no deformity" to type I (
JtM Hirashii). .

Although there was no obvious deformity, the anterior and posterior edges of the 7th thoracic vertebra and the center of the 10th thoracic vertebra tended to deteriorate. Also, the first
The center of the 0 thoracic vertebrae and the 3rd lumbar vertebrae have also deteriorated further.

On the other hand, the 6th. 8th. 9th. 11th. 12th thoracic vertebra, 4th.
Almost no change was observed in the 5th lumbar vertebrae).

[Brief explanation of drawings]

Figure 1 shows an fJ i X-ray image of the vertebral body, and Figure 2 shows the relationship between each vertebral body deformation, anterior line length (d), posterior edge length (cl, etc.) using the judgment method of the present invention. It shows the relationship,
Figure i@3 shows an example of vertebral body deformation. Patent originator Teijin Ltd. 9, -6゜ Agent Patent attorney 1) Jun Hiroshi J paper 1 figure box 2 figure 2 U goneyama j1 已 ken 2 1985 8122E1! 1 WI No. 1 ('white b role 1, display of matter f1! lh Application No. 61-103198 No. 2, title of the invention Thin body deformation determination method 4, agent specification Ji's "Detailed description of the invention `` column (d)'' should be changed to ``1 multi-en 艮 (c)'' and 9] 1 [2.
r11 constant), l iij, and according to the criteria, delete -(''.
Correct it to 0.70J. (4) 1■)” in the 4th line of 101ff+13sei becomes “■)”
Revised rF 7. (5) 11i1 15th negative 91j "-2σ" is "-
1.5σ” -L

Claims (1)

[Claims] 1. From the lateral X-ray image of the vertebral body, the median length (a) and the posterior edge length (c
), and the anterior edge length (d), and then calculate the ratios of c/d, a/c, and a/d, and from these c, d, c/d, a/c, and a/d, the vertebral body A method for determining vertebral body deformation characterized by determining the type of deformation of.