CT与MRI对胸腰椎爆裂性骨折合并后方韧带复合体损伤的评价及影响因素分析  

The evaluation and influence factors analysis of CT and MRI on thoracolumbar burst fracture combined with PLC injury

作　　者：王瑞波 王自涛 李燕平 孙邦建[1] Wang Ruibo;Wang Zitao;Li Yanping;Sun Bangjian(Department II of Spine and Bone Tumors,Handan First Hospital,Handan 056004,China)

机构地区：[1]邯郸市第一医院脊柱与骨肿瘤二科,邯郸056004

出　　处：《中国医学装备》2024年第6期50-55,共6页China Medical Equipment

基　　金：河北省医学科学研究课题计划项目(20231923)。

摘　　要：目的:探讨CT与MRI对胸腰椎爆裂性骨折合并后方韧带复合体(PLC)损伤的评价及影响因素。方法:选取2020年1月至2023年6月邯郸市第一医院诊治的68例胸腰椎爆裂性骨折患者,以手术结果为“金标准”,将其中32例确诊为胸腰椎爆裂性骨折并发PLC损伤患者纳入PLC组,36例未并发PLC损伤患者纳入非PLC组。所有患者均于术前行计算机断层扫描(CT)、磁共振成像(MRI)检查,采用四格表法计算CT、MRI诊断胸腰椎爆裂性骨折并发PLC损伤的阳性和阴性预测值,采用受试者工作特征(ROC)曲线分析CT、MRI诊断胸腰椎爆裂性骨折并发PLC损伤的ROC曲线下面积(AUC)值、灵敏度及特异度。采用logistic回归模型分析胸腰椎爆裂性骨折患者并发PLC损伤的危险因素,比较两组载荷分享评分系统(LCS)评分、椎管内占位率、胸腰椎损伤分类及严重程度(TLICS)评分,以及柯布(Cobb)角、椎体楔变角(SIEA)、局部后凸角(LK)及棘突间距增加值(IISD)的差异。结果:68例胸腰椎爆裂性骨折患者经CT检查后,其中34例显示PLC损伤,34例显示无PLC损伤,PLC损伤的阳性预测值为70.59%(24/34),阴性预测值为76.47%(26/34),与“金标准”相比,一致性一般(Kappa=0.471,P<0.001);经MRI检测后,其中33例显示PLC损伤,35例显示无PLC损伤,PLC损伤阳性预测值为90.91%(30/33),阴性预测值为94.29%(33/35),与“金标准”相比,一致性较好(Kappa=0.853,P<0.001)。MRI的诊断确诊率为92.65%(63/68),高于CT的73.53%(50/68),差异有统计学意义(χ^(2)=8.843,P<0.05)。ROC曲线分析显示,CT、MRI诊断胸腰椎爆裂性骨折并发PLC损伤的AUC分别为0.730、0.919;灵敏度分别为70.60%、75.40;特异度分别为88.20%、95.70%。PLC组与非PLC组患者的性别、年龄、体质量指数(BMI)、受伤原因、LCS评分以及椎管内占位率比较,差异无统计学意义(P>0.05);而在TLICS评分、Cobb角、SIEA、LK及IISD比较中,差异具有统计学意义(χ^(2)=19.443、4.181、4.973、Objective:To explore the evaluation and influence factors of computed tomography(CT)and magnetic resonance imaging(MRI)on thoracolumbar burst fracture combined with injury of posterior ligament complex(PLC).Methods:A total of 68 patients with thoracolumbar burst fractures who were diagnosed and treated in Handan First Hospital from January 2020 to June 2023 were selected as the research object,and the surgical result was used as gold standard.The 32 cases,who were diagnosed as thoracolumbar burst fractures combined with PLC injury according to the gold standard,were divided into PLC group.The 32 cases without PLC injury were divided into non-PLC group.Before operation,all patients underwent CT and MRI examinations,and the positively and negatively predictive values of CT and MRI in diagnosing thoracolumbar burst fracture combined with PLC injury were calculated by four-grid method.The area under curve(AUC)value,sensitivity and specificity of CT and MRI in diagnosing thoracolumbar burst fracture combined with PLC injury were analyzed by receiver operating characteristic(ROC)curve.Logistic regression model was used to analyze the risk factors of patients with thoracolumbar burst fracture who occurred PLC injury.The differences of the scores of ligamentous complex stability(LCS)score,intraspinal space occupancy rate and thoracolumbar injury classification and severity(TLICS)score,and the scoliosis angle(Cobb),superior iliac crest angle(SIEA),local kyphosis(LK)angle and intervertebral disc space depth(IISD)between two groups were compared.Results:For 68 with thoracolumbar burst fractures,the 34 cases were confirmed as PLC injury and 34 cases were confirmed as non-PLC injury by using CT examination.The positively and negatively predictive values of CT examination were respectively 70.59%(24/34)and 76.47%(26/34)for PLC injury,and the consistency between CT and gold standard was general(Kappa=0.471,P<0.001).The 33 cases were confirmed as PLC injury and 35 cases were confirmed as non-PLC injury by using MRI examination.T

关 键 词：计算体层成像(CT) 磁共振成像(MRI) 胸腰椎爆裂性骨折 后方韧带复合体损伤(PLC) 影响因素 

分 类 号：R816.8[医药卫生—放射医学]