创伤性胸腰椎骨折患者椎间盘损伤的危险因素及与骨折严重程度相关影像学参数的诊断效能

Risk Factors of Intervertebral Disc Injury in Patients with Traumatic Thoracolumbar Fracture and Diagnostic Efficacy of Imaging Parameters Related to Fracture Severity

目的:分析创伤性胸腰椎骨折患者椎间盘损伤的危险因素及与骨折严重程度相关影像学参数的诊断效能。方法:选择2019年2月—2022年5月在武威市中医医院住院治疗的116例创伤性胸腰段骨折患者作为研究对象,依据有无合并椎间盘损伤将其分为椎间盘损伤组(n=78)和无椎间盘损伤组(n=38)。比较两组一般资料、骨折严重程度相关影像学参数等,并采用ROC曲线分析骨折严重程度相关影像学参数对椎间盘损伤的诊断效能,采用多因素logistic回归分析创伤性胸腰椎骨折患者椎间盘损伤的危险因素。结果:椎间盘损伤组伤椎楔变角、椎管侵占率明显高于无椎间盘损伤组,伤椎前后缘高度比明显低于无椎间盘损伤组,差异有统计学意义(P<0.05);ROC曲线分析结果显示,伤椎楔变角、椎管侵占率和伤椎前后缘高度比联合诊断创伤性胸腰椎骨折腰椎间盘损伤的ROC曲线下面积明显高于三项指标单独诊断的ROC曲线下面积,差异有统计学意义(Z=3.062,P<0.05)。多因素logistic回归分析结果显示,结果显示伤椎楔变角≥22.67°、椎管侵占率≥23.29%和伤椎前后缘高度比<0.68均为创伤性胸腰椎骨折患者腰椎间盘损伤的独立危险因素(P<0.05)。结论:创伤性胸腰椎骨折患者椎间盘损伤与骨折严重程度有关,其CT影像学参数伤椎楔变角、椎管侵占率和伤椎前后缘高度比联合检测对椎间盘损伤诊断效能较高,且伤椎楔变角≥22.67°、椎管侵占率≥23.29%和伤椎前后缘高度比<0.68是创伤性胸腰椎骨折患者腰椎间盘损伤的独立危险因素。

Objective:To analyze the risk factors of intervertebral disc injury in patients with traumatic thoracolumbar fracture and the diagnostic efficacy of imaging parameters related to fracture severity.Method:A total of 116 patients with traumatic thoracolumbar fractures who hospitalized in Wuwei Hospital of Traditional Chinese Medicine from February 2019 to May 2022 were selected as the study subjects.They were divided into intervertebral disc injury group(n=78)and non-intervertebral disc injury group(n=38)according to the presence or absence of intervertebral disc injury.Compared the general data of two groups,the imaging parameters related to the fracture severity,and use the ROC curve to analyze the diagnostic efficacy of the imaging parameters related to the fracture severity on the intervertebral disc injury,and use multivariate logistic regression to analyze the risk factors of the intervertebral disc injury in patients with traumatic thoracolumbar fracture.Result:The wedged angle of the injured vertebra and the invasion rate of the vertebral canal in the intervertebral disc injury group were significantly higher than those in the non-intervertebral disc injury group,and the ratio of the height of the anterior and posterior edges of the injured vertebra was significantly lower than that in the non-intervertebral disc injury group,the differences were statistically significant(P<0.05);ROC curve analysis results showed that the area under the ROC curve of the combined diagnosis of traumatic thoracolumbar fracture and lumbar disc injury was significantly higher than the area under the ROC curve of the three indicators,the difference was statistically significant(Z=3.062,P<0.05).The results of multivariate logistic regression analysis showed that the wedge angle of the injured vertebra≥22.67°,the invasion rate of the vertebral canal≥23.29%and the ratio of the height of the anterior and posterior edge of the injured vertebra<0.68 were independent risk factors for lumbar disc injury in patients with traumatic thoracolumbar fracture(P<0.05).Conclusion:The intervertebral disc injury in patients with traumatic thoracolumbar fracture is related to the severity of the fracture.The combined detection of the CT imaging parameters of traumatic vertebral wedge change angle,vertebral canal invasion rate and the ratio of the height of the anterior and posterior edge of the injured vertebra is more effective in the diagnosis of the intervertebral disc injury,and the traumatic vertebral wedge change angle≥22.67°,vertebral canal invasion rate≥23.29%and the ratio of the height of the anterior and posterior edge of the injured vertebra<0.68 are independent risk factors of the lumbar disc injury in patients with traumatic thoracolumbar fracture.