创伤性胸腰椎骨折时后方韧带复合体的状态评估及其作用分析  

The evaluation of posterior ligament complex injury as well as the analysis of its effects in thoracic- lumbar fractures

作　　者：徐敏鸥 郑月焕[2] 曹鹏[2] 梁裕[2] 龚耀成[2] 郑涛[2] 张兴凯[2] 吴文坚[2] 

机构地区：[1]浙江省临海市第二人民医院骨科,317016 [2]上海交通大学医学院附属瑞金医院骨科 上海市伤骨科研究所

出　　处：《中华外科杂志》2011年第8期724-728,共5页Chinese Journal of Surgery

基　　金：上海市科学技术委员会自然科学基金资助项目（07ZR14096）;上海市卫生局科研基金资助项目（2007034）;上海市科学技术委员会生物医药及临床重大项目基金资助项目（10dz1950400）

摘　　要：目的评估创伤性胸腰椎骨折时后方韧带复合体（PLC）的状态及分析其对确立诊治原则的作用。方法选取2005年8月至2008年5月采用后路手术治疗的60例创伤性胸腰椎骨折患者，男性38例，女性22例，年龄21—65岁，平均34岁。根据AO胸腰椎骨折分类法，将其分为压缩或爆裂型骨折（A型）42例、屈曲牵张型损伤（B型）5例、骨折脱位型（C型）13例。采用磁共振成像（MRI）作为手术前PLC状态评估的主要方法，进行T1WI、T2WI、脂肪抑制序列扫描，并进行负片阅读。根据术前损伤节段处有无皮肤严重挫伤及凹陷、棘突间隙增宽及压痛，有无神经功能受累，X线或CT重建扫描有无椎体后凸或滑移的增加、关节突骨折或（半）脱位、棘突或椎板的横形骨折等进一步进行综合评估。与术中探查结果进行比较进行参数计算。结果术前60例患者PLC状态评估的灵敏度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为85．3％、80．8％、83．3％、85．3％、80．8％、19．2％、14．7％。在剔除了13例骨折脱位型病例后，47例患者PLC状态评估的灵敏度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为81．0％、80．8％、80．9％、77．3％、84．0％、19．2％、19．0％。术前MRI诊断的假阴性及假阳性各有5例。结论MRI是评估PLC状态的主要手段，尽管增加了脂肪抑制序列和负片阅读，目前仍不能完全准确地在术前判断PLC状态，必须结合相关的局部体检、其他影像学技术以及MRI图像上异常信号所出现的部位和损伤时间加以综合判断和分析。Objectives To evaluate and analyze the role of posterior ligment complex （PLC） in determining therapeutic principle for traumatic thorac-lumbar fracture. Methods From August 2005 to May 2008,60 patients （38 male, 22 female） who suffered from the traumatic thoracic-lumbar fracture were carried out posterior operations. According to the Magerl traumatic thorac-lumbar fracture classification system, these cases were classified to subtype A,B and C. The average age was 34 years （21-65 years）. Magnetic resonance imaging （MRI） scan, which including both T1/T2 weight and fat-stir sequence, as well as the MRI negative film reading technique were used to evaluate the state of PLC. Furthermore, related physical or neurological examinations（ such as severe skin bruising and sinking, broadening spinous process gap and tenderness, spinal cord or nerve root injury） and another X-ray or CT reconstruction films were taken to evaluate the the state of PLC synthetically . Above-mentioned results were compared with the final exploration results during operation and some parameters were analyzed. Results The sensitivity, specificity, accuracy, positive predictive value（ PPV）, negative predictive value （NPV）, misdiagnosis rate and rate of missed diagnosis of these sixty patients were 85.3%, 80. 8%, 83.3%, 85.3%, 80. 8%,19. 2%, 14.7% respectively. After 13 cases of thoracic-lumbar fracture-dislocation were eliminated, the sensitivity, specificity, accuracy, PPV, NPV, misdiagnosis rate and rate of missed diagnosis of remaining 47 cases were 81.0%, 80. 8%, 80. 9%, 77.3%, 84. 0% , 19. 2%, 19. 0% respectively. There were 5 cases with MRI negative results before operation hut positive results during operation. Contrarily, 5 cases with MRI positive results before operation but negative results during operation occurred. Conclusions MRI is a main means for evaluating the state of PLC. Although the MRI fat-stir sequence as well as the MRI negative film reading technique are adopted, the state of PLC can not be esti

关 键 词：脊柱骨折 磁共振成像 后方韧带复合体 分型 

分 类 号：R687.3[医药卫生—骨科学]