■评估后韧带复合体(PLC)的完整性,作为表征不稳定胸腰椎骨折(TLF)的关键要素,具有挑战性,但对治疗的选择至关重要。
■如何使用计算机断层扫描(CT)的组合参数创建可重复的评分来预测不明显的PLC损伤。CT参数与PLC状态的关系。
■急性创伤性TLF患者神经系统完整的回顾性分析,在72小时内接受CT和磁共振成像(MRI),在2016年1月至2022年之间的单个机构的急诊科。四名研究人员对MRI的CT和PLC完整性独立评估了11个参数。评估了CT参数的中间可靠性,并使用多变量逻辑回归系数创建两个风险评分来预测CT上的PLC损伤。
■包括154名患者,其中62例患有PLC损伤。所有CT测量都具有出色或良好的评分者间可靠性。椎板或椎弓根水平骨折(HLPF)的患者,棘突骨折(SPF)和棘突间距离扩大(IDW)与PLC损伤呈正相关(分别为p<0.001,p<0.001和p=0.045)。风险评分2(RS2),其中只包括有统计学意义的变量,共有75.9%的正确分类(p<0.001),评估MRI中检测到的PLC损伤的敏感性为71.0%,特异性为78.3%。
■在CT测量方案中预先建立的标准化程序是有效的。与早期发现一样,这三次CT测量显示与PLC损伤呈正相关,从而加强了以往研究的结论。与上述CT检查结果的可靠性相比,分数不太精确。
UNASSIGNED: Assessing the integrity of the posterior ligament complex (PLC), as a key element in the characterization of an unstable Thoracolumbar fracture (TLF), is challenging, but crucial in the choice of treatment.
UNASSIGNED: How to create a reproducible score using combined parameters of Computed Tomography (CT) to predict nonobvious PLC injury. How CT parameters relate with PLC status.
UNASSIGNED: Retrospective analysis of neurologically intact patients with an acute traumatic TLF, who underwent CT and Magnetic Resonance Imaging (MRI) within 72 h, in the Emergency Department of a single institution between January 2016 and 2022. Four investigators rated independently 11 parameters on CT and PLC integrity on MRI. The interrater reliability of the CT parameters was evaluated, and two risk scores were created to predict PLC injury on CT using the coefficients of the multivariate logistic regression.
UNASSIGNED: 154 patients were included, of which 62 with PLC injury. All CT measurements had excellent or good interrater reliability. Patients with Horizontal Fracture of the lamina or pedicle (HLPF), Spinous process fracture (SPF) and Interspinous Distance Widening (IDW) were positively associated with PLC injury (p < 0.001, p < 0.001 and p = 0.045, respectively). Risk Score 2 (RS2), which included only statistically significant variables, had a total of 75.9% of correct classifications (p < 0.001), with a sensitivity of 71.0% and specificity of 78.3% to estimate PLC injury detected in the MRI.
UNASSIGNED: Standardized procedures pre-established in the CT measurement protocol were effective. Identically to early findings, those three CT measurements showed a positive relation to PLC injury, thus enhancing the conclusions of previous studies. Comparing to the reliability of the CT findings above mentioned, the score was less precise.