MRI评估胸腰椎骨折后柱韧带复合体损伤的精确性研究

Accuracy evaluation of MRI in detecting posterior ligament complex injury associated with thoracolumbar factures

目的 研究MRI评估胸腰椎骨折后柱韧带复合体（posterior ligamentous complex,PLC）损伤的一致性. 方法 回顾性研究170例胸腰椎骨折患者的MRI资料,每例患者在伤后l周内行MRI检查,3位医师分别对MRI资料进行对比分析,探讨MRI评估PLC损伤的一致性及PLC损伤严重程度. 结果 观察者1和2的Kappa系数（K值）为0.85,观察者1和3的K值为0.77,观察者2和3的K值为0.79,观察者之间的可靠性非常吻合,总体K值为0.80.PLC损伤程度与脊髓神经损伤呈正相关（P＜0.05）. 结论 胸腰椎骨折中PLC损伤的准确评估有利于明确脊柱的机械稳定性,MRI评估PLC损伤的一致性程度高,值得临床推广.

Objective To investigate the consistency of MRI detecting posterior ligamentous complex （PLC） injury associated with thoracolumbar factures. Methods MRI data of 170 cases of thoracolumbar fractures were reviewed retrospectively. Each case underwent MRI around one week postin- jury. MRI data were analyzed and compared by three physicians respectively to discuss the consistency in MRI detection of PLC injury and the severity of PLC injury. Results Kappa coefficient was 0. 846 be- tween observer 1 and 2, 0. 768 between observer 1 and 3, and 0. 793 between observer 2 and 3. Interob- server reliability was high and overall Kappa coefficient was 0. 803. Severity of PLC injury was interrelat- ed with spinal cord nerve injury （ P 〈 0.05 ）. Conclusions Accurate detection of PLC injury in thora- columbar fractures is beneficial to clear the mechanical stability of the spine. MRI detection of PLC injury is of high consistency and hence deserves wide use.