64排螺旋CT在胸腰椎损伤TLICS分类系统中的应用价值

The Application Study of 64-slice Spiral CT in TLICS Classification System for Thoracolumbar Injury

目的:探讨64排螺旋CT扫描、多平面重组及三维容积重建在胸腰椎损伤分型和严重程度TLICS评分系统的价值。材料与方法:回顾性分析2014年10月至2016年10月期间的50例胸腰椎损伤患者,其中男性27例,女性23例,平均年龄(44±9.8)岁。所有患者均行64排螺旋CT扫描,采用矢状位MPR和三维容积再现(VR)技术进行处理,根据典型CT表现推断后方韧带复合体的损伤情况,并且利用胸腰椎损伤TLICS系统进行评分,TLICS分值>4分的病例通过手术证实。结果:50例胸腰椎损伤患者中,共检出76个椎节骨折和14例后方韧带复合体(PLC)损伤,其中单纯压缩型18例,爆裂型28例,平移/旋转型20例,牵张型10例;后方韧带复合体(PLC)损伤的CT表现有棘突撕脱骨折5例,椎体平移和旋转3例,关节突横行骨折2例,小关节脱位2例,棘突间隙增宽合并小关节脱位1例,棘突间隙增宽伴关节突骨折1例。结论:通过多平面重组及三维VR技术能有效检出骨折与脱位,提示PLC损伤,可作为胸腰椎损伤重要的检查手段之一,尤其是对于急诊患者,早期可用来指导临床进行TLICS评分。

Objective： To investigate application values of the Thoraco-Lumbar Injury Classification and Severity （TLICS） Classification System in thoracolumbar injury by using 64-slice spiral CT scan, multi-planar reconstruction （MPR） and three-dimensional volume reconstruction （VR）. Materials and Methods ： The retrospective study included 50 patients （27 males and average ages were 44＆#177;9.8） with thoracolumbar injury from October 2014 to October 2016. All patients were scanned by 64-slice spiral CT and performed the sagittal MPR and three-dimensional VR for imaging diagnosis. Then we evaluated the severity of posterior ligamentous complex （PLC） injury according to the typical CT features of thoracolumbar injury. When the TLICS score was higher than 4, we compared the CT features with surgical findings. Results：Seventy-six vertebral fractures were checked out in all 50 patients, included 18 compressed fractures, 28 burst fractures, 20 translation/rotation fractures, and 10 stretch fractures. In addition, 14 patients were found the PLC injuries with different CT imaging features, i.e. 5 avulsion fractures of spinous process, 3 translational and rotational malformation of centrum, 2 transverse fractures of articular process, 2 cases with facet dislocation, 2 broadened interspinous space complicated with facet dislocation and fracture of articular process respectively. Conclusions： Combined MPR and three-dimensional VR could effectively detect fractures and dislocations features indicating the injury of PLC. MPR and VR can be applied as the significant diagnostic examination method, especially to the emergency patients, which could be used for early clinical application of TLICS classification system.