MRI诊断胸腰椎骨折后柱韧带复合体损伤的可靠性研究

目的 探讨MRI诊断胸腰椎骨折患者后柱韧带复合体（posterior ligamentous complex，PLC）损伤的真实性与可靠性。方法2004年12月至2005年6月，胸腰椎骨折患者82例，男54例，女28例；年龄14-75岁，平均45．8岁；高处坠落伤47例，交通事故伤15例，重物压伤7例，其他损伤13例。82例患者中单节段骨折65例，双节段骨折16例，三节段骨折1例（有连续两个节段骨折），损伤节段共100处。术前对胸腰椎骨折患者进行MR检查，评价PLC损伤情况。术中探查并记录PLC损伤程度。分析MRI诊断PLC各部分损伤的灵敏度、特异度和符合率。结果 MRI诊断棘问韧带、棘上韧带和黄韧带损伤的灵敏度分别为92.3％、95.2％和93.3％，特异度分别为98．6％、98．7％和100．0％，符合率分别为97．0％、98．0％和99．0％。MRI显示小关节囊损伤22例，术中探查小关节囊损伤21例。MR检查PLC损伤的整体符合率Kappa值为0．786。结论 MRI是诊断PLC损伤的有效方法，具有灵敏度、特异度及符合率高的特点，与术中所见高度一致。

Reliability of magnetic resonance imaging in detecting posterior ligamentous complex injury associated with thoracic and lumbar fractures

Objective To assess the reliability of diagnosis for posterior ligamentous complex injury(PLC)in thoracic and lumbar fractures using MRI.Methods From December 2004 to June 2005,82 patients suffered thoracic and lumbar fractures were evaluated using MRI before operation.There were 54 males and 28 females,who ranged in age from 14 to 75 years(mean 45.8 years).The injuries were caused by falling for 47 cases,traffic accident for 15 cases,crush by heavy objects for 7 cases,other reasons for 13 cases.There were 65 cases injured in single segment,16 cases in two segments,and 1 case in three segments(including two consecutive segments fracture),totally 100 injured segments.All patients underwent MRI scan before operation to evaluate the status of PLC injury.During the operation,PLC was examined and recorded.We compared the results of MRI and what be seen during operation,to get the sensitivity,specificity,and accuracy of MRI.Results The sensitivity of MRI in evaluating interspinous ligament was 92.3%;specificity,98.6%;and accuracy,97.0%.In evaluating supraspinous ligament injury sensitivity was 95.2%;specificity,98.7%;and accuracy,98.0%.In evaluating ligamentous flavum injury sensitivity was 93.3%;specificity,100.0%;and accuracy,99.0%.Capsule of facet joint injuries were 22 in MRI findings and 21 in operative findings.The overall Kappa of PLC was 0.786.Conclusion A fat-suppressed T2-weighted sagittal and axial sequence of MRI was a highly sensitive,specific,and accurate method of evaluating PLC injury and MRI findings were high according with intraoperative findings.