多层螺旋CT在胸腰椎爆裂性骨折术前评估的应用价值

Application value of MSCT in preoperative assessment of thoracolumbar burst fracture

目的:探讨多层螺旋CT(MSCT)在胸腰椎爆裂性骨折术前评估的应用价值。方法:选取医院收治的158例胸腰椎爆裂性骨折患者,均行MSCT扫描检查,依据Oswestry功能障碍指数(ODI)评分将术后患者分为预后良好组(121例)和预后差组(37例),以手术病理结果为金标准,评估MSCT扫描检查在椎体骨折数目、伤椎分布和骨折分型等方面的诊断价值。比较两组术前椎体高度比和椎管狭窄率,分析MSCT在胸腰椎爆裂性骨折患者术前评估中的应用价值。结果:MSCT对胸腰椎爆裂性骨折患者椎体骨折总体检出率为98.16%,附件骨折检出率为98.76%,与手术病理结果比较差异无统计学意义(x^(2)=3.028,x^(2)=2.013;P>0.05)。MSCT对胸腰椎爆裂性骨折患者伤椎椎体分型诊断的准确率为94.38%,对胸腰椎爆裂性骨折患者骨折分型诊断的灵敏度、特异度和准确率分别为90.11%、82.61%和86.88%。术后患者椎体高度比与术前相比明显增加,患者椎管狭窄率和ODI评分则明显降低,差异均具有统计学意义(t=-41.567,t=123.093,t=102.478;P<0.05);预后优良组术前椎体高度比显著高于预后差组,椎管狭窄率明显低于预后差组,差异有统计学意义(t=10.031,t=7.888;P<0.05);术前椎体高度比和椎管狭窄率联合检测的受试者工作特征(ROC)曲线下面积(AUC)为0.817,特异度为85.0%,对患者预后有较高预测价值。结论:MSCT对胸腰椎爆裂性骨折患者骨折数目、骨折椎管分度及骨折分型的诊断与手术病理结果符合率较高,或可作为胸腰椎爆裂性骨折术前评估及术后预后判断的有效方案。

Objective:To explore the application value of multi-slice spiral computed tomography(MSCT)in preoperative assessment of thoracolumbar burst fractures.Methods:158 patients with thoracolumbar burst fracture who admitted to hospital were selected.All of the enrolled patients underwent MSCT scan examination.The postoperative patients were divided into favorable prognosis group(121 cases)and poor prognosis group(37 cases)according to the Oswestry dysfunction index(ODI)score.The pathological result of surgery was used as golden standard to assess the diagnostic value of MSCT scan examination in the number of vertebral fracture,the distribution of injured vertebra and the fracture classification.The preoperative height of vertebra and spinal stenosis rate between two groups were compared.And then,the application value of MSCT in preoperative assessment of patients with thoracolumbar burst fracture was further analyzed.Results:The total relevance rate of MSCT on vertebral fracture of patients with thoracolumbar burst fracture was 98.16%,and the relevance rate of accessory fracture was 98.76%,and the differences of them between MSCT and pathological results of surgery were no significant(x^(2)=3.028,x^(2)=2.013,P>0.05).The accuracy of MSCT was 94.38%on the diagnosis of vertebral classification of injured vertebra of patients with thoracolumbar burst fracture,and the sensitivity,specificity and accuracy of that was 90.11%,82.61%and 86.88%on the diagnosis of fracture classification of patients with thoracolumbar burst fracture,respectively.The height ratio of vertebra of patients after surgery was significantly higher than that before surgery,and the spinal canal stenosis rate and ODI score after surgery was significantly lower than that before surgery(t=-41.567,t=123.093,t=102.478,P<0.05),respectively.And the preoperative height ratio of favorable prognosis group was significantly higher than that of poor prognosis group,and the spinal canal stenosis rate of favorable prognosis group was significantly lower than that of poor prognosis group(t=10.031,t=7.888,P<0.05).The area under curve(AUC)of receiver operating characteristic(ROC)curve of the combined detection of preoperative height ratio of vertebra and spinal canal stenosis rate was 0.817,and the specificity of that was 85.0%,which has higher prediction value on the prognosis of patients.Conclusion:MSCT can achieve higher coincidence rate with pathological results of surgery in the diagnosis of the number of fractures,scale division of vertebral canal of fracture and fracture classification in patients with thoracolumbar burst fractures.And it might be used as effective scheme of preoperative assessment and postoperative prognosis judgment of thoracolumbar burst fractures.