骨性影像学参数对胸腰椎骨折PLC损伤诊断效能的研究

发布时间：2018-02-03 02:20

本文关键词： 后方韧带复合体胸腰段损伤体层摄影术　出处：《临床放射学杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的评估CT检查中骨性影像学参数(椎体楔变角、局部后凸角、椎体压缩率、棘突间距增加值和椎弓根间距增加值)对后方韧带复合体(PLC)损伤的诊断效能。方法回顾性分析2013年1月至2016年3月间外伤导致胸腰段(T_(11)~L_2)骨折的患者52例,所有患者进行CT平扫及多平面重组,测量椎体楔变角、局部后凸角、椎体压缩率、棘突间距增加值及椎弓根间距增加值等骨性参数,根据MRI结果,将PLC状态分为完整和损伤。先将骨性参数通过t检验进行筛选,将有统计学意义的骨性参数纳入二元Logistic回归模型分析单个参数与PLC损伤的相关性,使用受试者工作特性曲线(ROC)分析骨性影像学参数对PLC损伤的诊断效能。结果52例患者中,MRI显示23例出现PLC损伤。椎体楔变角(P=0.710)与局部后凸角(P=0.120)在无PLC损伤与PLC损伤组间无明显统计学差异。Logistic回归分析表明椎体压缩率与PLC损伤无明显相关(P=0.053)。棘突间距增加值(P=0.001)及椎弓根间距增加值(P=0.046)与PLC损伤存在相关。ROC分析显示:棘突间距增加值曲线下面积最大(AUC=0.807),其次是椎弓根间距增加值(AUC=0.666)。结论在各项骨性参数中,棘突间距增加值和椎弓根间距增加值是最有效的预测参数。当棘突间距增加值2.2 mm,椎弓根间距增加值1.0 mm时,两者联合诊断PLC损伤的敏感度为70%,特异度为93%。
[Abstract]:Objective to evaluate the bone imaging parameters (vertebral wedge angle, local kyphoid angle, vertebral compression ratio) in CT. The diagnostic efficacy of spinous process spacing and pedicle spacing in the diagnosis of posterior ligament complex (PLCs) injury was analyzed retrospectively from January 2013 to March 2016. There were 52 patients with tips. All the patients underwent plain CT scan and multiplanar reconstruction. Bone parameters such as vertebral wedge angle, local kyphoid angle, vertebral compression ratio, spinous process spacing and pedicle spacing were measured according to MRI results. The PLC status was divided into integrity and injury. Bone parameters were screened by t test. The correlation between the single parameter and PLC damage was analyzed by using the statistically significant bone parameters in the binary Logistic regression model. The effectiveness of bone imaging parameters in the diagnosis of PLC injury was analyzed by using the operating characteristic curve of the subjects. Results in 52 patients. MRI showed PLC injury in 23 cases. Vertebral wedge angle was 0.710) and local kyphoid angle was 0.120). There was no statistical difference between the groups without PLC injury and PLC injury. Logistic regression analysis showed that there was no significant correlation between vertebral compression ratio and PLC injury. The increased value of spinous process spacing (P0. 001) and pedicle spacing (P < 0. 046) were correlated with PLC damage. The results showed that the area under the curve was the largest (P < 0. 05). AUC 0.807). The second is the increase of pedicle spacing (AUC) 0.6660.Conclusion among all the bone parameters. The increase of spinous process spacing and pedicle spacing were the most effective predictive parameters, when the spinous process spacing increased 2.2 mm and the pedicle spacing increased 1.0 mm. The sensitivity and specificity of combined diagnosis of PLC injury were 70 and 933 respectively.
【作者单位】：苏州大学附属第一医院影像中心;
【分类号】：R687.3;R816.8
【正文快照】： 胸腰段是脊柱骨折最易受累的部位,胸腰段的骨折常导致相应节段后方韧带复合体(posterior lig- amentous complex,PLC)损伤。PLC由棘上韧带、棘间韧带、黄韧带和小关节囊组成,与前柱共同承担脊柱的纵向负荷,维持脊柱的稳定性。PLC缺乏血供,自愈能力差,受损后若不及时进行手术

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