胸腰段爆裂骨折合并Kummell病的MRI表现及其诊断价值

Imaging findings and diagnostic value of MRI on thoracolumbar burst fractures accompanied with Kummell's disease

目的:探讨胸腰段爆裂骨折合并Kummell病的MRI表现及其诊断价值。方法:回顾性分析四川省骨科医院102例疑似胸腰段爆裂骨折合并Kummell病患者资料,所有患者均行MRI检查,以临床手术结果诊断为金标准,研究MRI对胸腰段爆裂骨折合并Kummell病的诊断价值及对胸腰段骨折部位韧带损伤的检出情况,分析胸腰段爆裂骨折合并Kummell病的MRI表现。结果:102例患者中手术结果诊断胸腰段爆裂骨折合并Kummell病阳性58例,阴性44例,MRI诊断阳性60例,阴性42例,其中漏诊5例,误诊7例,诊断敏感度、特异度、准确率、阳性预测值、阴性预测值分别为91.37%、84.09%、88.23%、88.33%、88.09%,Kappa值为0.758,与手术结果具有较高的一致性;MRI对前纵韧带、后纵韧带、棘上韧带、棘间韧带损伤的检出率与手术结果比较,差异均无统计学意义(P>0.05);58例胸腰段爆裂骨折合并Kummell病患者中,MRI检查30例表现为不同程度的椎体压缩变扁,25例出现楔形改变,MRI平扫28例椎体内仍可见正常骨髓信号,54例患者椎体内可见斑片状T2WI低信号、压脂低信号影,4例患者椎体相应层面有薄层硬膜外血肿形成,33例患者损伤椎体T2WI呈低信号,17例患者损伤椎体T2WI呈高信号,韧带损伤区域呈黑色条带状结构断裂、T2WI呈高信号。结论:MRI对胸腰段爆裂骨折合并Kummell病具有较高的诊断价值,可清晰显示病变椎体信号特征。

Objective To explore the imaging findings and diagnostic value of magnetic resonance imaging(MRI)on thoracolumbar burst fractures accompanied with Kummell's disease.Methods A retrospective analysis was conducted on 102 patients with suspected thoracolumbar burst fractures accompanied with Kummell's disease in Sichuan Province Orthopedic Hospital.All patients underwent MRI examination.The clinical surgical diagnosis was taken as the gold standard to study the diagnostic value of MRI on thoracolumbar burst fractures accompanied with Kummell's disease and the detection of ligament injuries at thoracolumbar fracture site,and the MRI findings of thoracolumbar burst fractures accompanied with Kummell's disease were analyzed.Results The surgical results reported that out of 102 cases,58 cases were positive for thoracolumbar burst fractures accompanied with Kummell's disease and 44 cases were negative,while MRI diagnosis revealed that there were 60 positive cases and 42 negative cases,including 5 cases of missed diagnoses and 7 cases of misdiagnoses.MRI had a diagnostic sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa value of 91.37%,84.09%,88.23%,88.33%,88.09%and 0.758,respectively,indicating a high consistency with surgical results.The detection rates of anterior longitudinal ligament,posterior longitudinal ligament,supraspinous ligament and interspinous ligament injuries through MRI were close to surgical results(P>0.05).MRI examination showed various degrees of vertebral compression and flattening in 30 cases out of 58 cases of thoracolumbar burst fractures accompanied with Kummell's disease,and wedge-shaped changes in 25 cases.On MRI plain scan,normal bone marrow signals were still found in vertebral body in 28 cases.There were 54 cases with patchy T2WI hypointensity and lipid-suppression hypointensity in vertebral body,4 cases with thin epidural hematoma at corresponding level of vertebral body,33 cases with hypointensity on T2WI of the injured vertebral body, and 17 cases with hyperintensity on T2WI of the injured vertebral body, with the damaged ligament area beingblack banded structure fracture and hyperintensity on T2WI. Conclusion MRI has high diagnostic value on thoracolumbarburst fractures accompanied with Kummell's disease, and it can clearly display the signal characteristics of the diseasedvertebra.