X线片和CT影像对胸腰椎后方韧带复合体损伤的诊断意义

To evaluate the efficacy of X-ray plain film and computed tomography in detecting posterior ligamentous complex injury

中文关键词:  后方韧带复合体  脊柱骨折  上下终板角  棘突间距  Logistic模型  X线

英文关键词:Posterior ligamentous complex  Vertebral fracture  Superior and inferior endplate angle  Inter-spinous distance  Logistic models  X-ray

中文摘要:

  【摘要】 目的：评价X线片和CT影像在评估胸腰椎骨折中后方韧带复合体（PLC）损伤的应用价值。方法：回顾性分析2012年1月~2016年7月期间我院脊柱外科诊治的胸腰椎骨折患者。纳入标准：（1）胸椎或腰椎骨折病例；（2）有明确外伤史；（3）5d内完成X线片、CT和MRI检查。排除标准：（1）病理性骨折；（2）陈旧性椎体骨折；（3）伤椎或其邻近椎体合并有棘突骨折；（4）典型或非典型Chance骨折；（5）骨折合并椎体明显脱位或旋转；（6）2个及以上椎体骨折；（7）先天性或退变性脊柱侧凸。以MRI诊断作为参考标准，将PLC完整或部分损伤患者与PLC完全断裂患者的X线片或CT影像学征象进行比较，对有统计学显著性差异的参数进行组合，建立Logistic回归模型，以预测概率为分析指标，应用ROC曲线分析，评价不同组合对PLC损伤的诊断价值，找出诊断价值最高组合，在不同截止点上行平行、系列诊断试验。结果：共纳入符合标准的胸腰椎骨折患者120例，其中男78例，女42例；年龄16～67岁（43.4±16.2岁）。交通伤62例，高处坠落伤40例，压砸伤18例。骨折部位：胸椎30例，胸腰段64例，腰椎26例。X线片上测量的上下终板角（SIEAX）、椎体高度下降百分比（LOVBHX）和CT影像上测量的棘突间距差值（ISDFCT）有统计学意义（P＜0.01）。两参数组合中，SIEAX+ISDFCT的组合诊断效能最好，ROC曲线面积为0.844（0.746~0.942），与三参数组合无显著性差异，其截止点处Youden指数为0.675。选取该组合行平行诊断试验，在X线片上SIEA＞20°或CT影像上ISDF大于2mm时，其灵敏度为95.3%，特异度为62.8%，Youden指数为0.581。结论：X线片上测量SIEA＞20°或CT影像上测量ISDF＞2mm可作为PLC完全断裂的初筛标准。

英文摘要:

  【Abstract】 Objectives: To evaluate the efficacy of X-ray plain film and computed tomography in detecting posterior ligamentous complex(PLC) complete rupture through the combination of different parameters by using magnetic resonance imaging(MRI) as a reference. Methods: This was a retrospective review of patients with thoracic or lumbar vertebral fracture treated in the spine surgery department during January 2012 to July 2016. The inclusion criteria included: (1)thoracic or lumbar vertebral fracture; (2)definite history of trauma; (3)performed X-ray plain film, computed tomography and magnetic resonance examination in 5 days after injury. The exclusion criteria included: (1)pathological fracture; (2)old vertebral fracture; (3)combined with spinous process fracture; (4)chance fracture; (5)combined with vertebra dislocation or rotation distinctly; (6)two or more vertebral fractures; (7)congenital or degenerative scoliosis. These patients were divided into two groups according to the appearance of PLC in MRI. Then, parameters with significant difference in two groups were found out and ROC curve was applied to evaluate the diagnostic capacity of different combined parameters. Parallel test and serial test were performed on the combined parameters with supreme diagnostic capacity. Results: 120 out of 600 patients with thoracic or lumbar vertebral fractures were included in this study. There were 78 males and 42 females with an average age of 43.4±16.2 years(range 16-67 years). The cause of injury included traffic accident injury in 62 cases, falling injury in 40 cases and crush injury in 18 cases. The lesion site included thoracic vertebral fracture in 30 cases, lumbar vertebral fracture in 26 cases and thoracolumbar vertebral fracture in 64 cases, among whom 29 cases were with L1 injury as the most frequent segments. There was significant difference in the superior and inferior endplate angle(SIEA) and loss of vertebral body height(LOVBH) on plain and inter-spinous distance difference(ISDF) on CT. The area under ROC curve of SIEA+ISDF was 0.844 and Youden index was 0.675, which showed the highest diagnostic capacity of two-parameter combinations. No significant difference of AUC was found between two-parameter combinations and three-parameter combinations. The sensitivity, specificity, Youden index of the combination of SIEA>20° or ISDF>2mm were 95.3%, 62.8%, 0.581, respectively. Conclusions: The combination of SIEA>20° on plain or ISDF>2mm on CT might be acted as a screening measure in detecting posterior ligamentous complex complete rupture.