CAJ | 학술논문

目的：与单用 CT 检查相比较，加做 MRI 检查，评估 MRI 对胸腰椎损伤程度评分系统的影响和作用。方法回顾分析2010年1月至2013年12月期间的80例胸腰椎损伤患者，女性20例，平均年龄41.3岁（22~54岁），男性60例，平均年龄45.7岁（22~69岁）。所有患者均进行 X 线、CT 和 MRI 扫描。分析患者骨折数目及骨折节段；根据 TLICS 系统评定患者骨折形态为压缩损伤、爆裂骨折、平移/旋转、牵张损伤；后方韧带复合体（posterior ligamentous complex，PLC）的状态为无损伤、不确定损伤、损伤；评定神经功能状态，最终计算 TLICS 分值。第一次评估使用 X 线片和 CT 数据，6周后重复评定，同时加入 MRI 数据。使用 Wilcoxon 秩和检验比较分析 MRI 检查对 TLICS 损伤严重程度评估及对 TLICS 评分的改变。结果单纯 CT 检查发现128处胸腰椎骨折，CT + MRI 共发现23处新骨折，共151处骨折。CT 和 MRI 联用，PLC 损伤分级没有发生改变的63例（79%），95%的置信区间为（0.67，0.88）。发生改变的17例（21%），95% Wilson CI（0.13，0.31）。单用 CT 评估其 TLICS 评分平均分为2.1 分，而 CT + MRI 则平均为3.5分， Wilcoxon 秩和检验 P <0.001，Wilcoxon 效应值4.00，Wilson 95% CIs（3.00，5.00）。80例中，56例总分没有改变（70%），但24例出现改变（30%），其中损伤评分增加的22例，减小的2例。单用 CT 评定总分小于5分，而联合 MRI后总评分≥5分的患者共14例（18%），Wilson 95% CIs 为（0.10，0.31）。结论 CT 和 MRI 的结合比单用 CT 能够检出更多骨与韧带的损伤，可改变 TLICS 的分类及评分，MRI 检出的韧带损伤是分类发生改变的重要原因。
목적：여단용 CT 검사상비교，가주 MRI 검사，평고 MRI 대흉요추손상정도평분계통적영향화작용。방법회고분석2010년1월지2013년12월기간적80례흉요추손상환자，녀성20례，평균년령41.3세（22~54세），남성60례，평균년령45.7세（22~69세）。소유환자균진행 X 선、CT 화 MRI 소묘。분석환자골절수목급골절절단；근거 TLICS 계통평정환자골절형태위압축손상、폭렬골절、평이/선전、견장손상；후방인대복합체（posterior ligamentous complex，PLC）적상태위무손상、불학정손상、손상；평정신경공능상태，최종계산 TLICS 분치。제일차평고사용 X 선편화 CT 수거，6주후중복평정，동시가입 MRI 수거。사용 Wilcoxon 질화검험비교분석 MRI 검사대 TLICS 손상엄중정도평고급대 TLICS 평분적개변。결과단순 CT 검사발현128처흉요추골절，CT + MRI 공발현23처신골절，공151처골절。CT 화 MRI 련용，PLC 손상분급몰유발생개변적63례（79%），95%적치신구간위（0.67，0.88）。발생개변적17례（21%），95% Wilson CI（0.13，0.31）。단용 CT 평고기 TLICS 평분평균분위2.1 분，이 CT + MRI 칙평균위3.5분， Wilcoxon 질화검험 P <0.001，Wilcoxon 효응치4.00，Wilson 95% CIs（3.00，5.00）。80례중，56례총분몰유개변（70%），단24례출현개변（30%），기중손상평분증가적22례，감소적2례。단용 CT 평정총분소우5분，이연합 MRI후총평분≥5분적환자공14례（18%），Wilson 95% CIs 위（0.10，0.31）。결론 CT 화 MRI 적결합비단용 CT 능구검출경다골여인대적손상，가개변 TLICS 적분류급평분，MRI 검출적인대손상시분류발생개변적중요원인。
Objective To evaluate the influence and effect of MRI in addition to CT on the thoracolubar injury classifica-tion and severity score. Methods A retrospective analysis of 80 patients with thoracolumbar injury patients from January 2010 to December 2013 was performed. All patients in this study had X-ray,CT and MRI scans. The number and level of fractures in patients were analyzed. According to TLICS system,the injury morphology were classified into compression,burst,translation/rotation,and distraction;the status of PLC were ranked with intact,suspected/ indeterminate,and injured. Neurological status and TLICS score was also assessed and calculated. The first evaluation was done with X-ray and CT data. Six weeks later,the second evaluation was performed while adding MRI data. The changes of rank of injury and TLICS score were evaluated with Wilcoxon rank sum test. Results CT test alone revealed 128 thoracolumbar fractures,23 new fractures were found with CT +MRI with a total of 151 fractures. The proportion of patients whose PLC assessment did not change using CT and MRI data to-gether amountedto0 . 79,with95 % WilsonCI( 0 . 67 ,0 . 88 ). Thechangedamountedto0 . 21 ,with95 % WilsonCI( 0 . 13 , 0. 31). The median TLICS using CT alone was 2. 1,whereas the median TLICS with CT and MRI together was 3. 5,Wilcoxon effect 4. 00,Wilcoxon P < 0. 001,with 95% Wilson CIs(3. 00,5. 00). In 56 out of 80 cases,the TLICS remained unchanged using CT and MRI together,but it changed in 24patients(30% ,upgraded 22 cases;downgraded 2 cases). The proportion of patients with a TLICS on CT < 5 and ≥ 5 on CT and MRI together amounted to 1 4( 0 . 1 8 ),with 9 5 % Wilson CIs( 0 . 1 0 , 0. 31). Conclusion The combination of CT and MRI can detect more bone and ligament injury than CT alone,and change the TLICS classification and score. Ligementous injures revealed by MRI were mainly responsible for these changes.