【摘要】 目的 分析磁共振检查(Magnetic Resonance Imaging,MRI)在胸腰椎急性创伤性骨折中的诊断和治疗中的临床应用。方法 回顾性分析北京市垂杨柳医院胸腰椎急性创伤性患者病历资料,这些患者均行骨折的X线平片、CT和MRI检查,排除了既往胸腰椎手术病史、骨质疏松骨折或者病理性骨折。分析骨折的X线平片和CT检查,确定AO分型及胸腰椎损伤分型和严重程度评分(thoracolumbar injury classification and severity score,TLICS)并制定治疗原则。分析MRI影像包括T1加权像、T2加权像和压脂(Fat-suppression,FS)像,再次依据TLICS系统及AO系统进行分型并制定治疗方案,比较分析MRI检查之前和之后的诊断和治疗方面的变化。结果 39例患者进入研究,平均年龄(40.1±17)岁。通过X线平片和CT检查,诊断了48处骨折,MRI新发现了13处骨折,11处椎体骨挫伤。MRI修正了43.6%患者的诊断(17例患者发现24处隐性损伤),30.8%患者骨折分类有改变(大部分由A类升级为B类),17.9%患者治疗方案有所变化。结论 MRI是一个有效评价胸腰椎急性骨折的工具,它能够更好的观察后方结构的完整性和累及的节段,与传统的诊断工具相比能够提供更多的信息。更多还原

【Abstract】 Objective To investigate the significance of magnetic resonance imaging(MRI) in diagnosis and treatment of thoracolumbar fractures.Methods We conducted a retrospective study to analyze clinical data in thoracolumbar traumatic fracture patients,who were enrolled Beijing Chuiyangliu hosptial after suffering an acute traumatic thoracolumbar fracture.Osteoporotic or pathologic fractures were excluded.Fractures were initially classified using X-ray and CT scan following the AO classification,and were graded by thoracolumbar injury classification and severity score(TLICS).The teatment principles were made.Afterward,MRI was performed with Tl,T2-weighted and FS sequences.Subsequently,fractures were classified according to the TLICS system and reclassified following the AO system.Analysis was performed before and after MRI on diagnostic changes,occult fractures and differences in treatment decision making.Results Thirty nine patients with an average age of 40.1± 17 years were studied.Forty-eight fractures were initially diagnosed using plain X-rays and CT scans,while MRI diagnosed 13 fractures and 11 vertebral contusions.MRI modified our diagnosis in 42.6%of our patients(discovering 17 patients with 24 occult injuries),the classification of fracture pattern in 30.8%of the fractures(mostly upgrading type A to type B patterns)and the therapeutic management in 17.9%of our patients.Conclusion MRI is a useful tool in the evaluation of thoracolumbar acute fractures,because it allows a better visualization of the posterior complex integrity and of the levels involved,offering additional information compared to traditional diagnostic tools.更多还原