椎弓根区域骨质疏松状态的影像学评估与康复策略优化:一项基于CT与MRI比较研究OA

Objective:To compare the predictive value of CT-based pedicle Hounsfield unit(HU)measurements and MRI-based pedicle bone quality(PBQ)scores for pedicle screw loosening(PSL)after posterior lumbar interbody fusion(PLIF)in elderly patients,and to identify the optimal bone mineral density(BMD)assessment index for perioperative reha-bilitation decision-making.Methods:A retrospective analysis was conducted in consecutive hospitalized patients who underwent PLIF.L1 vertebral and pedicle HU values were obtained from CT,while vertebral bone quality(VBQ)scores and PBQ scores were derived from MRI.Logistic regression anal-ysis was performed to identify risk factors associated with PSL.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of pedicle HU val-ues and PBQ scores for PSL,with further comparison against L1 HU values and VBQ scores.Results:The incidence of PSL was 20.41％(60/294).Compared with the non-loosening group,the loosening group had significantly higher postop-erative low back pain visual analogue scale scores(P＜0.05),lower Ll HU values(P＜0.001)and pedicle HU values(P＜0.001),and higher VBQ scores(P＜0.001)and PBQ scores(P＜0.001).Logistic regression analysis showed that L1 HU value(OR=0.98,95％CI=0.97-0.99,P＜0.001),pedicle HU value(OR=0.99,95％CI=0.98-0.99,P＜0.001),VBQ score(OR=2.66,95％CI=1.38-5.14,P=0.004),and PBQ score(OR=3.72,95％CI=2.01-6.89,P＜0.001)were all independent predictors of PSL.The areas under the ROC curve for L1 HU value,pedicle HU value,VBQ score,and PBQ score were 0.757,0.773,0.675,and 0.701,respectively.The optimal cutoff value of pedicle HU for predicting PSL was 225.33,with a sensitivity of 77.64％and a specificity of 69.34％.Conclusion:Pedicle HU value dem-onstrates superior predictive performance for PSL compared to PBQ score,emerging as the most robust BMD assessment index in this study.Preoperative measurement of pedicle HU facilitates identification of patients at high risk for subopti-mal pain relief and delayed functional recovery,providing evidence for stratified perioperative rehabilitation management,individualized instrumentation strategies,and targeted anti-osteoporosis interventions-ultimately contributing to enhanced functional reconstruction and improved rehabilitation outcomes.