外伤患者腹部序列CT图像对胸腰段椎体骨折的评估及椎体序列扫描必要性探讨  

Evaluation of abdominal CT for thoracolumbar spinal fractures and exploration of necessity of spine CT scan in trauma patients

作　　者：张保朋[1] 王道清[1] 郭伟[1] 陈星[2] ZHANG Bao-peng;WANG Dao-qing;GUO Wei;CHEN Xing(Department of Radoilogy,the First Affiliated Hospital of Henan Uneiversity of Chinese Medicine,Zhengzhou 450000,China;Orthopedic Dept.the First Affiliated Hospital of Henan Uneiversity of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院放射科,郑州450000 [2]河南中医药大学第一附属医院骨伤科,郑州450000

出　　处：《医药论坛杂志》2025年第1期105-109,F0003,共6页Journal of Medical Forum

摘　　要：目的对比分析腹部序列CT图像和椎体序列CT图像对外伤患者胸腰段椎体骨折的诊断效能,探讨外伤患者评估椎体骨折时,在有腹部CT图像的条件下有无增加椎体序列CT扫描的必要。方法回顾性收集并分析2020年1月至2022年12月河南中医药大学第一附属医院腹部序列CT图像和椎体序列图像均有的62例外伤患者资料。由两位放射医师对腹部序列CT图像和椎体序列CT图像分别进行有无骨折、骨折轻型或重型、骨折Denis分类的评估。以两位放射医师和一位骨科医师共同评估结果为标准,分别计算两位观察者根据腹部序列图像和椎体序列图像对椎体骨折诊断的敏感度、特异度和曲线下面积(area under curve,AUC)。两位观察者间、腹部序列和椎体序列两组图像之间评估结果的一致性采用Kappa检验。比较并计算单独腹部序列扫描与腹部序列联合椎体序列扫描的有效辐射剂量(effective radiation dose,ED)。结果62例患者共发现176个椎体骨折;其中轻型骨折98个,重型骨折78个;根据Denis分类重型骨折包括34个压缩型骨折、23个爆裂型骨折、16个屈曲牵张型骨折和5个骨折脱位。观察者1根据腹部序列图像和椎体序列图像对有无骨折诊断的敏感度分别为93.3%和96.0%、特异度分别为99.7%和99.7%、AUC分别为0.973和0.979,差异无统计学意义(P>0.05)。观察者2根据腹部序列图像和椎体序列图像对有无骨折诊断的敏感度分别为93.3%和96.6%、特异度分别为100%和100%、AUC分别为0.974和0.983,差异无统计学意义(P>0.05)。两名观察者之间、两组序列图像之间对有无骨折、骨折轻型或重型、骨折Denis分类的Kappa分析均显示为几乎完全一致(Kappa值0.968~1.000)。单独腹部序列扫描较腹部序列联合椎体序列扫描ED降低约47.3%。结论腹部序列CT扫描图像对外伤患者胸腰段椎体骨折的诊断效能及一致性与椎体序列CT图像相当,无须额外椎体Objective To analyze and compare the diagnosis value of abdominal CT images and spine CT images for thoracolumbar spinal fractures and to explore the necessity of additional spine CT scan with abdominal CT images in trauma patients.Methods The institutional review board approved this retrospective study.The data of 62 trauma patients which both had abdominal CT images and spine CT images in the First Affiliated Hospital of Henan Uneiversity of Chinese Medicine from January 2020 to December 2022 were retrospectively collected.Two radiologists independently evaluated the detection of spinal fractures,minor or major fractures and Denis type according to abdominal CT images and spine CT images respectively.Taking comprehensive assessment results as standard,the diagnostic sensitivity,specificity and area under curve(AUC)of two observers based on the two series of images were calculated respectively.Interobserver agreement was accessed by using Kappa test.Effective radiation doses(ED)of single abdominal CT scan and abdominal CT combined with spine CT scan were calculated and compared.Results Totally 176 fractures were found in 62 trauma patients,including 98 minor fractures and 78 major fractures.According to Denis type,the 78 major fractures consisted of 34 compression fractures,23 burst fractures,16 flexion distraction fractures and 5 fracture dislocations.The sensitivity,specificity and AUC of observer 1 based on abdominal CT images and spine CT images were 93.3%and 96.0%,99.7%and 99.7%,0.973 and 0.979,respectively,and the difference was statistically significant(P>0.05).And these of observer 2 were 93.3%and 96.6%,100%and 100%,0.974 and 0.983,respectively,and the difference was statistically significant(P>0.05).The interobserver agreement between two observes and between abdominal CT images and spine CT images for the fractures detection,and the identification of minor and major fractures and Denis typing all showed almost perfect agreement(Kappa:0.968-1.000).The ED saving of single abdominal CT scan compared to ab

关 键 词：体层摄影 X线计算机 外伤 胸腰段椎体 骨折 

分 类 号：R816.8[医药卫生—放射医学]