| Objective:To investigate whether the imaging abnormalities in thoracolumbar burst fracture(TLBF)can predict the posterior ligamentous complex (PLC) injury, to provide imaging standards for PLC damage and references for treatment strategies making of TLBF.Methods:Retrospect analysis of monosegment TLBF patients received treatment in the department of orthopedics of First Affiliated Hospital of Chongqing Medical University from the year 2010 March to 2014 March, a total of 131 cases were found, when strictly limited exclusion and inclusion criteria,56 patients were included finally. All patients had complete X ray, CT, three-dimensional reconstruction CT and MRI, using the Picture Archiving & Communication System (PACS) in our hospital to measurement and calculate the following imaging parameters on X ray, CT cross section and three-dimensional CT sagittal image:loss of vertebral height(LOVBH), segement kyphosis angel (SKA), local kyphosis angel (LKA), vertebral body translation, sagittal transverse ratio(STR), interlaminar distance (ILD), interspinous distance (ISD), supraspinous distance(SSD) and increased interpedicular distance (IPD). All measurements were repeated 3 times, calculated the average values. And then used the blind method to evaluate the integrity of the PLC, which based on magnetic resonance T1/T2 weighted images and short time inversion recovery or turbo inversion recovery magnetic sequence(STIR/TIRM), and the results were divided into injury group (P group) and normal group (C group), analysisd the differences of the abnormal imaging parameters above and some corresponding threshold between the two groups, found out the independent imaging risk factors of PLC damage using multivariate logistic regression analysis; at the same time, the total score derived from the Thoracolumbar Injury Classification and Severity Score(TLICS) were also evaluated between the two groups.Results:According to the interpretation of the MRI, a total of 33 patients had PLC damage (18 male,15 female)and 23 cases not had (13 male,10 female), when compared between the two groups, the TLICS score of P group were significantly higher than that in the C group (P< 0.001). LOVBH, subjacent translation, STR,%ILD,% ISD and increasd IPD between the two groups had no significant differences (P>0.05); while the SKA, LKA and% SSD in P group were higher than those in C group (P< 0.05), also the LKA>20° in the P group (15 cases) were significantly higher than those in the C group (2 cases) (P< 0.01).Single factor regression analysis showed that SKA、LKA、LKA、 20° and% SSD had significance differences between the two groups. But multivariate logistic regression analysis showed only LKA> 20° and % SSD were independent risk factors for PLC injury in patients with TLBF, the odds ratio [95% confidence interval] were 1.20 (1.02-1.40) and 27.33 (8.86-871.62) respectively, p<0.05). After testing, the multivariate logistic model was significant.Conclusions:Most imaging parameters, such as SKA, LOVBH, vertebral body translation, STR,%ILD,%ISD and IPD do not correlate with the presence of a PLC injury in patients with TLBF, but LKA> 20° and a high % SSD are risk factors of PLC injury. Therefore, patients with LKA>20° and a high % SSD were recommended using STIR or TIRM sequence MRI to evaluate the PLC state, as CT or T1/T2 MRI alone can not effectively diagnosis or exclusion of PLC damage, it will be helpfull to provide imaging standards for the treatment decisions making by judging the stability of TLBF based on the integrity of PLC. |
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