Department of Nuclear Medicine, Ulsan University Hospital, Ulsan 44033, Korea.
Department of Orthopedics, Dongkang Medical Center, Ulsan 44033, Korea.
Medicina (Kaunas). 2022 Jul 22;58(8):979. doi: 10.3390/medicina58080979.
: Unstable thoracolumbar burst fractures require surgical management as they can result in neurological deficits if left untreated. This study aimed to evaluate whether a new bone scan scoring system could accurately assess instability in thoracolumbar burst fractures. : Fifty-two patients with thoracolumbar burst fractures who underwent bone scans and magnetic resonance imaging prior to surgery between January 2015 and August 2017 at Ulsan University Hospital were selected for inclusion. Instability was determined by clinical assessment and imaging, and the Thoracolumbar Injury Classification and Severity score was determined. Bone scans were visually evaluated using a new bone scan scoring system. Bone scan findings of vertebral body (B) and posterior column (B) were scored separately and were summed to produce B {B (total score) = B (body score, 5 points) + B (posterior score, 2 points)}. The diagnostic performance of the scoring system for identifying unstable then thoracolumbar burst fractures were assessed. : Of the 52 thoracolumbar burst fractures, 34 (65.4%) were unstable and 31 (59.6%) had a Thoracolumbar Injury Classification and Severity score ≥ 5. The diagnostic performance of using B ≥ 4 to identify unstable thoracolumbar burst fractures and those with a Thoracolumbar Injury Classification and Severity score ≥ 5 was as follows: sensitivity, 61.8% and 58.1%; specificity, 94.4% and 81.0%; positive predictive value, 95.5% and 81.8%; and negative predictive value, 56.7% and 56.7%, respectively. : The proposed bone scan scoring system has a high specificity and positive predictive value for identifying thoracolumbar burst fractures that are unstable or have a Thoracolumbar Injury Classification and Severity score ≥ 5. This scoring system may help to inform decisions regarding surgical management.
不稳定的胸腰椎爆裂性骨折需要手术治疗，如果不及时治疗，可能导致神经功能缺损。本研究旨在评估新的骨扫描评分系统是否能准确评估胸腰椎爆裂性骨折的不稳定性。
选取 2015 年 1 月至 2017 年 8 月期间在蔚山大学医院接受手术治疗的 52 例胸腰椎爆裂性骨折患者，所有患者术前均行骨扫描和磁共振成像检查。通过临床评估和影像学检查确定不稳定，采用胸腰椎损伤分类及严重程度评分确定。采用新的骨扫描评分系统对骨扫描进行视觉评估。分别对椎体（B）和后柱（B）的骨扫描结果进行评分，相加得出 B 总分（B 总分=B 体评分（5 分）+B 后柱评分（2 分））。评估该评分系统对诊断不稳定胸腰椎爆裂性骨折的诊断性能。
52 例胸腰椎爆裂性骨折中，34 例（65.4%）为不稳定骨折，31 例（59.6%）胸腰椎损伤分类及严重程度评分≥5 分。采用 B≥4 诊断不稳定胸腰椎爆裂性骨折和胸腰椎损伤分类及严重程度评分≥5 分的诊断性能如下：敏感性分别为 61.8%和 58.1%；特异性分别为 94.4%和 81.0%；阳性预测值分别为 95.5%和 81.8%；阴性预测值分别为 56.7%和 56.7%。
该骨扫描评分系统对诊断不稳定或胸腰椎损伤分类及严重程度评分≥5 分的胸腰椎爆裂性骨折具有较高的特异性和阳性预测值。该评分系统可能有助于指导手术治疗决策。
