无神经症状胸腰椎爆裂骨折中椎间盘损伤与骨折严重程度的相关性

Correlation between disc injury and parameters of vertebral body damage in patients with neurologically intact thoracolumbar bust fractures

目的观察无神经症状胸腰椎爆裂骨折中椎间盘损伤与伤椎椎体骨折严重程度的相关性，并为进一步行MRI检查提供一定理论依据。方法采用回顾性病例系列研究分析2015年1月-2015年12月收治的22例（44个椎间盘）无神经症状胸腰椎骨折（T11～L2）患者临床资料。其中男12例，女10例；年龄43～60岁，平均47．9岁。基于MRI对伤椎上下椎间盘进行损伤分级：0级18个，1级11个，2级12个，3级3个。将0级或1级的患者归为椎间盘完整组（10例），其余为椎间盘损伤组（12例）。基于CT重建图像判断骨折严重程度，测量伤椎楔变角、局部后凸角、伤椎及邻近上下椎体前后缘高度比、椎管侵占率。采用Spearman相关系数评估骨折严重程度与椎间盘损伤分级的相关性，比较两组骨折严重程度的差异性，绘制受试者T作特征（ROC）曲线评估骨折严重程度指标判断椎间盘损伤的诊断价值。结果伤椎楔变角（P〈0．05）、伤椎前后缘高度比（P〈0．01）与伤椎上位椎间盘损伤严重程度相关。两组椎管侵占率、伤椎楔变角、伤椎前后缘高度比差异有统计学意义（P〈0．05或0．01）。ROC曲线结果显示，椎管侵占率、伤椎楔变角、伤椎前后缘高度比的曲线下面积分别为0．758，0．762，0．867，三者间差异无统计学意义（P〉0．05）。最佳阈值分别为椎管侵占21％，伤椎前后缘高度比0．69，伤椎楔变角15．4。结论伤椎楔变角、伤椎前后缘高度比与伤椎上位椎间盘损伤密切相关。椎管侵占率〉21％或伤椎楔变角〉15。或伤椎前后缘高度比〉0．69可作为无神经症状胸腰椎爆裂骨折进一步行MRI检查评估椎间盘损伤的指标。

Objective To assess the disc injury in neurologically intact thoracolumbar bust fractures and to evaluate the correlation between the severity of disc injury and the parameters of vertebral body damage as as to formulate radiologic index for further MRI examination. Methods A retrospective case series review was made on 22 patients （44 discs ） with thoracolumbar burst fractures without neurologic deficit treated from January 2015 to December 2015. Vertebral level involved was from T11-L2. There were 12 males and 10 females, with the mean age of 47.9 years （range, 43-60 years）. MRI were used to evaluate the severity of disc injury. Among the 44 discs, 18 were Grade 0, 11 were Grade 1, 12 were Grade 2, and three were Grade 3. Then patients with Grade 0 and 1 were taken as disc intact group and other 12 patients disc rupture group. Vertebral wedge angle, local kyphosis angle, anterior and posterior vertebral body height and canal compromise were measured on CT to determine the damage of fracture. Spearman correlation coefficient was used to analyze the correlation between the severity of disc injury and the parameters of vertebral body damage, and receiver operative curve （ ROC ） was used to assess the effectiveness of these indexes in predicting disc injury. Results Vertebral wedge angle and anterior/posterior vertebral body height ratio were correlated with the severity of superadjacent disc injury （ P 〈 0.05 or 0.01 ）. Canal compromise, vertebral wedge angle and anterior/posterior vertebral body height ratio were significantly different between the two groups （P 〈 0.05 or 0.01 ）. ROC results showed the area under curve of canal compromise, vertebral wedge angle and anterior/posterior vertebral body height ratio were 0. 758, 0. 762, and 0. 867 respectively, indicating no significant difference （P 〉 0.05）. Threshold of canal compromise, vertebral wedge angle and anterior/posterior vertebral body height ratio were 21%, 15.4°, and 0.69 respectively. Conclusions Vertebral wedge angle and anterior/posterior vertebral body hight ratio are correlated with the severity of superadjaceut disc injury. Canal compromise 〉21% , VWA 〉 15~and anterior/posterior vertebral body height ratio 〉 0.69 may be the practice preferences of indications for ordering a MRI in patients with neurologically intact thoracolumbar bust fractures.