中国骨质疏松杂志

老年胸腰椎病理性骨折患者入院、影像与病理诊断的一致性分析

Consistency analysis of admission diagnosis, imaging tests and histopathological results in elderly patients with thoracolumbar fracture

DOI：10.3969/j.issn.1006-7108.2025.11.010

中文关键词: 胸腰椎骨折骨质疏松影像学检查病理诊断老年

英文关键词:thoracolumbar vertebral fracture osteoporosis imaging tests pathologic diagnosis old age

基金项目:江西省重点研发计划项目（20223BBG71S02）；江西省“双千计划”首批培养类项目

作者	单位
鄢光奎1，2 刘文彩3 刘家明1，2 吴金法1，2 张宁4 周荣平1，2 陈宣银1，2 刘志礼1，2 黄山虎1，2 杜浏学1，2*	1.南昌大学第一附属医院骨科，江西南昌 330006 2.脊柱脊髓系统疾病江西省重点实验室，江西南昌 330006 3.上海交通大学医学院附属第六人民医院骨科，上海 200233 4.南昌大学第一附属医院影像科，江西南昌 330006

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中文摘要:

目的分析因骨质疏松性胸腰椎骨折入院的老年患者（≥60岁）的入院诊断、影像诊断与术后组织病理学诊断的一致性。方法回顾性分析南昌大学第一附属医院骨科2013年1月1日至2022年12月31日因“骨质疏松性椎体骨折”入院患者的病例资料，收集患者的入院诊断、术前影像学诊断（X线、CT、MRI）和术后组织病理学诊断结果。分析入院诊断、影像诊断与术后病理诊断的一致性。结果共纳入907例患者，其中男性193例，女性714例，平均年龄（74.92±7.59）岁。所有患者入院后均接受病椎穿刺活检术，术后病理诊断为骨折820例（90.4%），肿瘤34例（3.8%），感染53例（5.8%）。以术后病理诊断结果为金标准，入院诊断的准确率为90.4%，一致性较强（Kappa=0.673）；X线对老年骨质疏松性胸腰椎骨折检出的灵敏度为98.6%，特异度为73.7%，准确度为96.2%，阳性预测值为97.2%，阴性预测值为84.8%，一致性较强（Kappa=0.768）；CT对老年骨质疏松性胸腰椎骨折检出的灵敏度为96.5%，特异度为84.4%，准确度为95.1%，阳性预测值为97.9%，阴性预测值为76.1%，一致性较强（Kappa=0.772）；MRI对老年骨质疏松性胸腰椎骨折检出的灵敏度为98.2%，特异度为81.8%，准确度为97.1%，阳性预测值为98.7%，阴性预测值为76.3%，一致性最好（Kappa=0.774）。结论老年胸腰椎病理性骨折患者，入院诊断存在一定的误诊率，术前MRI检查诊断的准确度最高，且与术后病理诊断的一致性最好。

英文摘要:

Objective To analyze the consistency between the admission diagnosis, imaging tests, and pathological diagnosis in patients with pathological fractures of the thoracolumbar spine. Methods A retrospective analysis was conducted on the case data of patients admitted to the Orthopedics Department of the First Affiliated Hospital of Nanchang University from January 1, 2013 to December 31, 2022 due to "osteoporotic vertebral fractures". The admission diagnosis, preoperative imaging diagnosis (X-ray, CT, MRI), and postoperative histopathological diagnosis results of the patients were collected. Analyzed the consistency between admission diagnosis, imaging diagnosis, and postoperative pathological diagnosis. Results A total of 907 patients were included in the study, including 193 males and 714 females, with an average age of 74.92±7.59 years. All patients underwent vertebral biopsy after admission, and postoperative pathological diagnosis was 820 cases (90.4%) of fractures, 34 cases (3.8%) of tumors, and 53 cases (5.8%) of infections. Using postoperative pathological diagnosis results as the gold standard, the accuracy of admission diagnosis was 90.4%, with strong consistency (Kappa=0.673); the sensitivity of X-ray in detecting osteoporotic fractures was 98.6%, the specificity was 73.7%, the accuracy was 96.2%, the positive predictive value was 97.2%, and the negative predictive value was 84.8%, with a strong consistency (Kappa=0.768); the sensitivity of CT in detecting osteoporotic fractures was 96.5%, the specificity was 84.4%, the accuracy was 95.1%, the positive predictive value was 97.9%, and the negative predictive value was 76.1%, with a strong consistency (Kappa=0.772); the sensitivity of MRI in detecting osteoporotic fractures was 98.2%, the specificity was 81.8%, the accuracy was 97.1%, the positive predictive value was 98.7%, and the negative predictive value was 76.3%, with a strong consistency (Kappa=0.774). Conclusion In elderly patients with pathological fractures of thoracolumbar vertebra, there was a certain misdiagnosis rate in the admission diagnosis, and the preoperative MRI examination had the highest diagnostic accuracy and the best consistency with the postoperative pathological diagnosis.

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