Dai Li-Yang, Ding Wen-Ge, Wang Xiang-Yang, Jiang Lei-Sheng, Jiang Sheng-Dan, Xu Hua-Zi
Department of Orthopedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Trauma. 2009 Jun;66(6):1610-5. doi: 10.1097/TA.0b013e3181848206.
No consensus has been reached on the optimal radiographic evaluation of thoracolumbar burst fractures. The role of MRI in the treatment decision is not fully documented. The objectives was to measure the agreement of MRI in detecting posterior ligamentous complex (PLC) and posterior longitudinal ligament (PLL) injury, and to determine whether the findings by MRI is correlated with the results of plain radiography and computed tomography (CT) scanning as well as neurological examination and with the treatment planning.
Sixty-one patients with acute thoracolumbar burst fracture were retrospectively reviewed for the presence of supraspinous ligament (SSL), interspinous ligament (ISL) or posterior longitudinal ligament (PLL) injury. The overall interobserver agreement between the three different observers was assessed by a kappa coefficient for multiple raters. The status of ligaments was correlated with the neurological function as assessed by Frankel scale and fracture severity as defined by the Load Sharing Classification. These patients were surgically treated according to the Load Sharing Classification and followed up for at least 5 years.
The kappa coefficients for ISL or SSL injury ranged 0.601 to 0.736, representing substantial to almost perfect agreement, whereas the kappa coefficients for PLL injury were 0.441 to 0.574, representing moderate agreement. No significant difference (P > 0.05) of Frankel scale or load sharing score was found between patients with and without ligamentous injuries. Satisfactory results were achieved in all patients regarding the clinical and radiological assessment.
MRI is reliable for detecting the ligamentous injury, especially PLC injury in thoracolumbar burst fractures but the ligamentous injury as shown by MRI is not correlated with the neurological function or fracture severity. As MRI finding is of little value in treatment planning of thoracolumbar burst fractures, MRI examination is not necessary to be used routinely for excluding occult ligamentous injury.
对于胸腰椎爆裂骨折的最佳影像学评估尚未达成共识。MRI在治疗决策中的作用尚未完全记录。目的是测量MRI在检测后韧带复合体（PLC）和后纵韧带（PLL）损伤方面的一致性，并确定MRI结果是否与X线平片、计算机断层扫描（CT）以及神经学检查结果和治疗计划相关。
回顾性分析61例急性胸腰椎爆裂骨折患者的棘上韧带（SSL）、棘间韧带（ISL）或后纵韧带（PLL）损伤情况。通过多评价者kappa系数评估三位不同观察者之间的总体观察者间一致性。韧带状态与Frankel分级评估的神经功能以及载荷分担分类定义的骨折严重程度相关。这些患者根据载荷分担分类进行手术治疗，并随访至少5年。
ISL或SSL损伤的kappa系数范围为0.601至0.736，代表实质性至几乎完美的一致性，而PLL损伤的kappa系数为0.441至0.574，代表中等一致性。有韧带损伤和无韧带损伤的患者在Frankel分级或载荷分担评分方面无显著差异（P>0.05）。所有患者在临床和影像学评估方面均取得了满意的结果。
MRI在检测胸腰椎爆裂骨折的韧带损伤，尤其是PLC损伤方面是可靠的，但MRI显示的韧带损伤与神经功能或骨折严重程度无关。由于MRI结果在胸腰椎爆裂骨折的治疗计划中价值不大，因此无需常规使用MRI检查来排除隐匿性韧带损伤。
