摘要
目的探讨X线、CT、MRI检查在胸腰段骨折胸腰椎损伤分类及损伤程度评分(TLICS)中的可信度和可重复性。方法对34例胸腰段骨折患者分别行X线、CT、MRI检查,将影像学资料提供给6名医生(3名脊柱外科医生和3名影像科医生),骨折形态学和后部韧带复合体完整性由6名医生进行评分,神经学状况由脊柱外科医生单独评分,1个月后再次评分。采用加权Cohen′s Kappa系数评价观察X线、CT、MRI检查可信度和可重复性。结果6名医生对34例胸腰段骨折进行了2次评分,共408例次。TLICS评分<4分者126例次(30.88%);TLICS评分=4分者48例次(11.76%);TLICS评分>4分者234例次(57.35%)。①骨折形态评分:X线、CT、MRI检查的可信度Kappa系数分别为0.284、0.785、0.422;可重复性Kappa系数分别为0.836、0.895、0.763。②后部韧带复合体完整性评分:X线、CT、MRI检查的可信度Kappa系数分别为0.124、0.465、0.868;可重复性Kappa系数分别为0.874、0.795、0.824。结论3种影像学检查中,CT对胸腰段骨折TLICS评分中骨折形态可信度和可重复性较高,MRI次之,X线较差;MRI对胸腰段骨折TLICS评分中后部韧带复合体完整性评分的可信度和可重复性较高,CT次之,X线较差。CT、MRI对胸腰段骨折TLICS评分中骨折形态和后部韧带复合体完整性评分均具有较好的临床实用价值。
Objective To investigate the reliability and repeatability of X-ray,CT and MRI examination in thoracolumbar injury classification and severity score(TLICS)of thoracolumbar fractures.Methods A total of 34 patients with thoracolumbar fractures were prospectively selected,of whom repeatedly underwent X-ray,CT or MRI of the thoracolumbar segment of spine.Data from the 34 patients were provided to 6 doctors(3 spinal surgeons and 3 radiologists).Morphology of CT data and posterior ligament complex integrity were respectively scored by 6 doctors,their neurological statuses were scored separately by spinal surgeons,repeat score was performed after 1 month.Weighting Cohen′s Kappa coefficient was utilized to evaluate feasibility and intra-observer reproducibility of observers.Results In the two scoring,all six physicians scored 34 thoracolumbar fractures for a total of 408 times.There were 126,48 and 234 case-times with TLICS<4,TLICS=4,TLICS>4,respectively,accounting for 30.88%,11.76%and 57.35%.①Fracture morphology score:the reliability for Kappa coefficients of X-ray,CT and MRI were 0.284,0.785 and 0.422,respectively;the repeatability for Kappa coefficients were 0.836,0.895 and 0.763,respectively.②Posterior ligament complex integrity score:the reliability for Kappa coefficients of X-ray,CT and MRI were 0.124,0.465 and 0.868,respectively;the repeatability for Kappa coefficients were 0.874,0.795 and 0.824,respectively.Conclusions Among the three kinds of iconographies,the TLICS of CT for thoracolumbar fractures manifest high reliability and reproducibility of fracture morphology,followed by MRI,and the X-ray(poor);the TLICS of MRI for thoracolumbar fractures reveal high reliability and reproducibility of posterior ligament complex integrity,followed by CT,and the X-ray(poor).CT and MRI are with better clinical practical value in evaluating of fracture morphology and integrity of posterior ligament complex in TLICS of thoracolumbar fractures.
作者
谢凤鸣
李晓庆
陈中银
谭毅
李健宇
张春
XIE Feng-ming;LI Xiao-qing;CHEN Zhong-yin;TAN Yi;LI Jian-yu;ZHANG Chun(Dept of Radiology,Bazhou District People′s Hospital of Bazhong City,Bazhong Hospital of TCM,Bazhong,Sichuan 630057,China)
出处
《临床骨科杂志》
2020年第5期626-628,共3页
Journal of Clinical Orthopaedics
