MSCT在胸腰椎爆裂性骨折术前分型及术后疗效评估中的应用价值  

Application value of MSCT in preoperative classification of thoracolumbar burst fracture and postoperative evaluation on treatment efficacy

作　　者：张婷玉 王斌杰 胡亚萍 黄晓莹 Zhang Tingyu;Wang Binjie;Hu Yaping;Huang Xiaoying(Imaging Center,Kaifeng People's Hospital,Kaifeng 475002,China;Department of Imaging,Huaihe Hospital of Henan University,Kaifeng 475002,China)

机构地区：[1]开封市人民医院影像中心,开封475002 [2]河南大学淮河医院影像科,开封475002

出　　处：《中国实用医刊》2024年第16期64-67,共4页Chinese Journal of Practical Medicine

基　　金：河南省科技发展计划项目(202102310087)。

摘　　要：目的探讨多层螺旋CT(MSCT)在胸腰椎爆裂性骨折术前分型及术后疗效评估中的应用价值。方法抽取2021年7月至2023年6月开封市人民医院收治的胸腰椎爆裂性骨折患者70例,按照术后4个月Oswestry功能障碍指数(ODI)评分分为预后良好组(ODI评分<50分,54例)和预后不良组(ODI评分≥50分,16例)。以手术检查结果为金标准,分析MSCT对胸腰椎爆裂性骨折患者术前骨折分型、术前椎管分度的诊断准确率,分析椎体高度比、椎管狭窄率对胸腰椎爆裂性骨折患者预后的预测价值。结果MSCT检查术前对胸腰椎爆裂性骨折A型的诊断准确率为95.24%(40/42),B型的诊断准确率为78.57%(22/28),总体准确率为88.57%(62/70),Kappa=0.76,P<0.001。MSCT检查术前对胸腰椎爆裂性骨折椎管分0、1、2、3度的诊断准确率,分别为90.48%(19/21)、86.21%(25/29)、81.25%(13/16)、75.00%(3/4),总体准确率为85.71%(60/70),Kappa=0.79,P<0.001。预后不良者椎体高度比低于预后良好者,椎管狭窄率高于预后良好者(t=6.62、5.44,P均<0.05)。椎体高度比和椎管狭窄率预测胸腰椎爆裂性骨折患者预后的曲线下面积(AUC)(95%CI)分别为0.84(0.793~0.985)、0.75(0.700~0.802),截点值分别为0.700~0.802、58.85%,特异度分别为66.06%、57.34%,灵敏度分别为90.77%、90.77%;两项指标联合预测的曲线下面积(95%CI)为0.90(0.851~0.953),特异度为85.09%,灵敏度为84.24%。结论MSCT在胸腰椎爆裂性骨折患者术前骨折分型和椎管分度诊断中具有较好的临床应用价值,且可用于评估患者术后恢复情况。Objective To investigate the application value of multi-slice spiral computed tomography(MSCT)in preoperative classification of thoracolumbar burst fracture and postoperative evaluation on treatment efficacy.Methods A total of 70 patients with thoracolumbar burst fracture admitted to Kaifeng People’s Hospital from July 2021 to June 2023 were selected.According to the Oswestry dysfunction index(ODI)score 4 months after operation,the selected patients were divided into a good prognosis group(ODI score<50,54 cases)and a poor prognosis group(ODI score≥50,16 cases).Taking the results of surgical examination as the gold standard,the diagnostic accuracy of MSCT in preoperative fracture classification and preoperative spinal canal stenosis grading in patients with thoracolumbar burst fracture was analyzed.And the significance of vertebral height ratio and spinal canal stenosis rate in prediction on the prognosis of patients with thoracolumbar burst fracture were analyzed.Results The accuracy of MSCT in preoperative prediction of thoracolumbar burst fracture type A was 95.24%(40/42),the accuracy of MSCT for type B was 78.57%(22/28),and the overall accuracy was 88.57%(62/70),Kappa=0.76,P<0.001.The accuracy of MSCT in preoperative prediction of thoracolumbar burst fracture at 0,1,2 and 3 degrees were 90.48%(19/21),86.21%(25/29),81.25%(13/16)and 75.00%(3/4),respectively,and the overall accuracy was 85.71%(60/70),Kappa=0.79,P<0.001.The vertebral body height ratio in patients with poor prognosis was lower than that in patients with good prognosis,and the rate of spinal canal stenosis was higher than that in good prognosis(t=6.62,5.44;all P<0.05).The 95%CI for area under the curve of vertebral body height ratio and spinal canal stenosis rate in the predicting prognosis of thoracolumbar burst fracture were 0.84(0.793-0.985)and 0.75(0.700-0.802),the cut-off values of them were 0.700-0.802 and 58.85%,the specificity of them were 66.06%and 57.34%,moreover,the sensitivities were 90.77%and 90.77%,respectively.The 95%CI for area u

关 键 词：骨折 胸腰椎爆裂性骨折 多层螺旋CT 骨折分型 椎管分度 

分 类 号：R687.3[医药卫生—骨科学]