CT、MRI在胸腰椎骨折后方韧带复合体损伤诊断中的效能及影像特点观察OA
Efficacy and Imaging Features of CT and MRI in the Diagnosis of Posterior Ligamentous Complex Injury in Thoracolumbar Fracture
目的:观察CT、MRI在胸腰椎骨折后方韧带复合体(PLC)损伤诊断中的效能及影像特点.方法:选取2021年6月至2024年6月绵阳市骨科医院诊治的106例胸腰椎骨折患者,所有患者均于术前行CT、MRI检查,以手术结果为金标准,分析CT、MRI单独及联合对胸腰椎骨折PLC损伤的诊断效能,采用Kappa一致性检验法评估CT、MRI单独及联合对胸腰椎骨折PLC损伤诊断结果与手术结果的一致性,并观察其影像特征,与非PLC损伤对照分析.结果:手术结果显示,106例胸腰椎骨折患者中,PLC损伤50例,无PLC损伤56例.与手术结果对照,CT诊断胸腰椎骨折PLC损伤的敏感度、特异度、准确率、阳性和阴性预测值为74.00％、85.71％、80.19％、82.22％和78.69％,与金标准相比,一致性中等(Kappa=0.600);MRI诊断胸腰椎骨折PLC损伤的敏感度、特异度、准确率、阳性和阴性预测值为80.00％、89.29％、84.91％、86.96％和83.33％,与金标准相比,一致性良好(Kappa=0.696);CT联合MRI诊断胸腰椎骨折PLC损伤的敏感度、特异度、准确率、阳性和阴性预测值为96.00％、98.21％、97.17％、97.96％和96.49％,与金标准相比,一致性较高(Kappa=0.943).CT联合MRI诊断胸腰椎骨折PLC损伤的敏感度、特异度、准确率、阳性和阴性预测值均高于CT、MRI单独诊断(P＜0.05).CT显示,PLC损伤患者棘突撕脱性骨折、关节突横行骨折、棘突间隙增宽、骨折旋转、脱位及成角发生率为36.00％、24.00％、30.00％、16.00％、40.00％、12.00％,高于无PLC损伤患者(P＜0.05);MRI显示,PLC损伤患者T2WI高信号或连续性中断、韧带增厚、韧带缩短伴信号不均、椎旁肌间隙模糊、硬膜外血肿发生率为38.00％、20.00％、10.00％、42.00％、16.00％,高于无 PLC损伤患者(P＜0.05).结论:CT联合MRI 可提高对胸腰椎骨折PLC损伤的诊断效能,能够为临床诊疗提供可靠信息.然而,本研究金标准仅以术中所见为依据,未来需进一步改进方法学设计.
Objective:To observe the efficacy and imaging features of CT and MRI in the diagnosis of posterior ligamentous complex(PLC)injury in thoracolumbar fracture.Methods:A total of 106 patients with thoracolumbar fracture who were diagnosed and treated at Mianyang Orthopedic Hospital from June 2021 to June 2024 were selected.All patients underwent CT and MRI examinations before surgery.With surgical results as the gold standard,the diagnostic efficacy of CT,MRI,and combination of the two for PLC injury in thoracolumbar fracture was analyzed.Kappa consistency test was used to evaluate the consistency between the diagnostic results of CT,MRI and combination of the two for PLC injury in thoracolumbar fracture and surgical results.The image characteristics were observed and a comparative analysis with non-PLC injury was conducted.Results:Surgical results showed that among 106 patients with thoracolumbar fractures,50 had PLC Injury and 56 had no PLC Injury.Compared with surgical results,the sensitivity,specificity,accuracy,positive and negative predictive values of CT for diagnosing PLC injury in thoracolumbar fracture were 74.00％,85.71％,80.19％,82.22％and 78.69％,respectively(Kappa=0.600).The sensitivity,specificity,accuracy,positive and negative predictive values of MRI for diagnosing PLC injury in thoracolumbar fracture were 80.00％,89.29％,84.91％,86.96％and 83.33％,respectively(Kappa=0.696).The sensitivity,specificity,accuracy,positive and negative predictive values of CT combined with MRI for diagnosing PLC injury in thoracolumbar fracture were 96.00％,98.21％,97.17％,97.96％and 96.49％,respectively(Kappa=0.943).The sensitivity,specificity,accuracy,positive and negative predictive values of CT combined with MRI were higher than those of CT or MRI(P＜0.05).CT examination revealed that the incidences of avulsion fractures of the spinous process,transverse fractures of the facet joint,widened spinous process space,fracture rotation,dislocation and angulation in patients with PLC injury were 36.00％,24.00％,30.00％,16.00％,40.00％and 12.00％respectively,which were higher than those in patients without PLC injury(P＜0.05).MRI examination revealed that the incidences of high signal or continuity interruption on T2WI,ligament thickening,ligament shortening with uneven signal,blurred paraspinal muscle space,and epidural hematoma in patients with PLC injury were 38.00％,20.00％,10.00％,42.00％,and 16.00％respectively,which were higher than those in patients without PLC injury(P＜0.05).Conclusion:CT combined with MRI can improve the diagnostic efficacy of PLC injury in thoracolumbar fractures and provide reliable information for clinical diagnosis and treatment.However,the gold standard of this study is based only on the intraoperative observations,and the methodological design needs to be further improved in the future.
黄樱长;王富春;刘纯;卜发平;胡伟
绵阳市骨科医院放射科,四川 621000绵阳市骨科医院放射科,四川 621000绵阳市骨科医院放射科,四川 621000绵阳市骨科医院放射科,四川 621000绵阳市骨科医院放射科,四川 621000
医药卫生
胸腰椎骨折后方韧带复合体损伤CTMRI诊断效能影像特点
thoracolumbar fractureposterior ligamentous complex injuryCTMRIdiagnostic efficacyimaging features
《影像科学与光化学》 2026 (4)
55-60,6
四川省卫生健康委员会科研项目(17PJ207).
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