Azevedo Joana Araújo de, Martins Carolina Garcez, Oliveira Nuno, Varanda Pedro, Direito-Santos Bruno
Department of Orthopedic Surgery of Hospital de Braga, Braga, Portugal.
School of Medicine, Minho University, Braga, Portugal.
Brain Spine. 2024 Jul 1;4:102855. doi: 10.1016/j.bas.2024.102855. eCollection 2024.
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.
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.
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.
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.
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.
评估后韧带复合体（PLC）的完整性是一项具有挑战性的工作，但对于不稳定型胸腰椎骨折（TLF）的特征描述而言，它是关键要素，并且在治疗选择中至关重要。
如何使用计算机断层扫描（CT）的综合参数创建一个可重复的评分，以预测不明显的PLC损伤。CT参数与PLC状态如何相关。
对2016年1月至2022年期间在单一机构急诊科就诊的急性创伤性TLF且神经功能完好的患者进行回顾性分析，这些患者在72小时内接受了CT和磁共振成像（MRI）检查。四名研究人员独立对CT上的11个参数和MRI上的PLC完整性进行评分。评估CT参数的评分者间信度，并使用多变量逻辑回归系数创建两个风险评分以预测CT上的PLC损伤。
纳入154例患者，其中62例存在PLC损伤。所有CT测量的评分者间信度均为优秀或良好。椎板或椎弓根水平骨折（HLPF）、棘突骨折（SPF）和棘突间距离增宽（IDW）的患者与PLC损伤呈正相关（分别为p < 0.001、p < 0.001和p = 0.045）。仅包含具有统计学意义变量的风险评分2（RS2）的正确分类率总计为75.9%（p < 0.001），估计MRI中检测到的PLC损伤的灵敏度为71.0%，特异度为78.3%。
CT测量方案中预先建立的标准化程序是有效的。与早期研究结果一致，这三项CT测量结果均显示与PLC损伤呈正相关，从而强化了先前研究的结论。与上述CT检查结果的可靠性相比，该评分的精确性较低。
