CAJ | 학술논문

目的评估创伤性胸腰椎骨折时后方韧带复合体(PLC)的状态及分析其对确立诊治原则的作用.方法选取2005年8月至2008年5月采用后路手术治疗的60例创伤性胸腰椎骨折患者,男性38例,女性22例,年龄21～65岁,平均34岁.根据AO胸腰椎骨折分类法,将其分为压缩或爆裂型骨折(A型)42例、屈曲牵张型损伤(B型)5例、骨折脱位型(C型)13例.采用磁共振成像(MRI)作为手术前PLC状态评估的主要方法,进行T1WI、T2WI、脂肪抑制序列扫描,并进行负片阅读.根据术前损伤节段处有无皮肤严重挫伤及凹陷、棘突间隙增宽及压痛,有无神经功能受累,X线或CT重建扫描有无椎体后凸或滑移的增加、关节突骨折或(半)脱位、棘突或椎板的横形骨折等进一步进行综合评估.与术中探查结果进行比较进行参数计算.结果术前60例患者PLC状态评估的灵敏度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为85.3%、80.8%、83.3%、85.3%、80.8%、19.2%、14.7%.在剔除了13例骨折脱位型病例后,47例患者PLC状态评估的灵敏度、特异度、准确度、阳性预测值、阴性预测值、误诊率、漏诊率分别为81.0%、80.8%、80.9%、77.3%、84.0%、19.2%、19.0%.术前MRI诊断的假阴性及假阳性各有5例.结论 MRI是评估PLC状态的主要手段,尽管增加了脂肪抑制序列和负片阅读,目前仍不能完全准确地在术前判断PLC状态,必须结合相关的局部体检、其他影像学技术以及MRI图像上异常信号所出现的部位和损伤时间加以综合判断和分析.
목적 평고창상성흉요추골절시후방인대복합체(PLC)적상태급분석기대학립진치원칙적작용.방법 선취2005년8월지2008년5월채용후로수술치료적60례창상성흉요추골절환자,남성38례,녀성22례,년령21～65세,평균34세.근거AO흉요추골절분류법,장기분위압축혹폭렬형골절(A형)42례、굴곡견장형손상(B형)5례、골절탈위형(C형)13례.채용자공진성상(MRI)작위수술전PLC상태평고적주요방법,진행T1WI、T2WI、지방억제서렬소묘,병진행부편열독.근거술전손상절단처유무피부엄중좌상급요함、극돌간극증관급압통,유무신경공능수루,X선혹CT중건소묘유무추체후철혹활이적증가、관절돌골절혹(반)탈위、극돌혹추판적횡형골절등진일보진행종합평고.여술중탐사결과진행비교진행삼수계산.결과 술전60례환자PLC상태평고적령민도、특이도、준학도、양성예측치、음성예측치、오진솔、루진솔분별위85.3%、80.8%、83.3%、85.3%、80.8%、19.2%、14.7%.재척제료13례골절탈위형병례후,47례환자PLC상태평고적령민도、특이도、준학도、양성예측치、음성예측치、오진솔、루진솔분별위81.0%、80.8%、80.9%、77.3%、84.0%、19.2%、19.0%.술전MRI진단적가음성급가양성각유5례.결론 MRI시평고PLC상태적주요수단,진관증가료지방억제서렬화부편열독,목전잉불능완전준학지재술전판단PLC상태,필수결합상관적국부체검、기타영상학기술이급MRI도상상이상신호소출현적부위화손상시간가이종합판단화분석.
Objectives To evaluate and analyze the role of posterior ligment complex (PLC) in determining therapeutic principle for traumatic thorac-lumbar fracture.Methods From August 2005 to May 2008,60 patients (38 male, 22 female) who suffered from the traumatic thoracic-lumbar fracture were carried out posterior operations.According to the Magerl traumatic thorac-lumbar fracture classification system, these cases were classified to subtype A, B and C.The average age was 34 years (21-65 years).Magnetic resonance imaging (MRI) scan, which including both T1/T2 weight and fat-stir sequence, as well as the MRI negative film reading technique were used to evaluate the state of PLC. Furthermore, related physical or neurological examinations( such as severe skin bruising and sinking, broadening spinous process gap and tenderness, spinal cord or nerve root injury ) and another X-ray or CT reconstruction films were taken to evaluate the the state of PLC synthetically.Above-mentioned results were compared with the final exploration results during operation and some parameters were analyzed. Results The sensitivity,specificity, accuracy, positive predictive value( PPV ), negative predictive value ( NPV ), misdiagnosis rate and rate of missed diagnosis of these sixty patients were 85.3%, 80.8%, 83.3%, 85.3% , 80.8%,19.2% , 14.7% respectively. After 13 cases of thoracic-lumbar fracture-dislocation were eliminated, the sensitivity, specificity, accuracy, PPV, NPV, misdiagnosis rate and rate of missed diagnosis of remaining 47 cases were 81.0% , 80.8% , 80.9% , 77.3% , 84.0% , 19.2%, 19.0% respectively. There were 5 cases with MRI negative results before operation but positive results during operation Contrarily, 5 cases with MRI positive results before operation but negative results during operation occurred. Conclusions MRI is a main means for evaluating the state of PLC. Although the MRI fat-stir sequence as well as the MRI negative film reading technique are adopted, the state of PLC can not be estimated exactly before operation (especially for those unfracture dislocation cases). In order to estimate the state of PLC exactly, the related local physical examination and image technology as well as the location of the abnormal image signal in MRI film and time of injury must be analyzed synthetically.