胸腰椎爆裂性骨折后部韧带复合体损伤的MRI诊断

目的:探讨核磁共振成像(MRI)诊断胸腰椎爆裂性骨折中后部韧带复合体(PLC)损伤的准确性及损伤机制.方法:将60例胸腰椎爆裂性骨折病人术前MRI诊断结果与手术结果相对比,得出MRI诊断后部韧带复合体中棘上韧带(SSL)和棘间韧带(ISL)损伤的准确率.将病人分为PLC完整组和PLC损伤组,对比两组间脊髓神经损伤程度及椎板骨折发生率大小.结果:MRI诊断SSL和ISL损伤的准确率分别为89.6%和93.0%,T1加权像诊断SSL损伤特异度明显高于T2加权像(P＜0.05).PLC损伤组中病人脊髓神经损伤程度及椎板骨折发生率均明显高于PLC完整组(P＜0.05).结论:MRI检查是诊断胸腰椎爆裂性骨折中后部韧带复合体损伤的可靠工具.

Diagnosis of magnetic resonance imaging for detecting posterior ligamentous complex injury associated with thoracolumbar burst fractures

Objective: To discuss the accuracy of magnetic resonance imaging (MRI) for diagnosing posterior ligamentous complex (PLC) injury associated with thoracolumbar burst fractures and the injury mechanisms. Methods: We compared the preoperative MRI findings with direct introperative observation of sixty patients who sustained thoracolumbar burst fractures,clarified the diagnostic accuracy regarding detection of supraspinous ligament (SSL) and interspinous ligament (ISL) which comprised the posterior ligamentous complex. Between patients with and without PLC injury, the degree of the neurological injury and the incidence of luminar fractures were compared. Results: The diagnostic accuracy of MRI in detecting injury of SSL and ISL was 89.6% and 93.0% respectively. The specificity of T1-weighted MRI for depicting the SSL was significantly greater than that of T2-weighted imaging (P<0.05). In the PLC injury group,the degree of the neurological injury and the incidence of luminar fractures were significantly greater than those of the PLC intact group (P<0.05) . Conclusion: MRI is a reliable diagnostic tool to evaluate PLC injury associated with thoracolumbar burst fractures.