| Objective: With the aging situation in China continuously accelerating,the number of patients who were suffering from vertebral osteoporotic compression fractures(OVCFs)increasing,which makes the percutaneous vertebral plasty(PKP)can be effective in the treatment of OVCFs method was widely used in clinical,in the same time complications brought by PKP are getting more and more.But the percutaneous kyphoplasty operation is possible increase the risk of adjacent vertebral fractures,this is possible attributed to the natural course of vertebral osteoporosis or the stress concentration between the strenghten vertebra and its adjacent vertebrae.There is no effective prediction method of adjacent vertebral fractures after PKP,so this paper tries to use CT value to predict the risk of adjacent vertebral fractures,then using statistical methods to analyze the agreement and reliability across different observers.Methods: All of the cases who was performed with PKP after osteoporotic vertebral compressive fractures and hospitalized in the spinal surgery department again of the ×× Hospital of ×× University were collected from Jun.1st,2015 to Dec.31 st,2016.149 patients were found in total,nineteen cases who were followed up less than a year were excluded.The rest of 130 cases were found that there were 19 males and 111 females,20 cases were found with adjacent vertebral fractures.Three cases which were not with adjacent vertebral fractures were excluded,the remaining 17 cases were found there were 12 female cases and 5 male cases,minimal age was 51 years old,maximal age was 88 years old,mean age is 69.81 ± 8.58 years old.Hospital information searching system was used to collect the X-ray,CT and MRI images of above mentioned 17 cases by two independent doctors.By the hospital PACSimage system,six doctors through the patient's X-ray slice respectively measured per patient technique vertebral and fluctuation velocity of the vertebral body,during and after the three column height,take the average value,estimated as the average height of vertebral bodies.Using Photoshop CS 6.0 system,using the "pixel" imaging principle,measurement technique vertebral and vertebral vertebral bodies in the up and down of the narrow cross-sectional area,the estimation for the cross-sectional area of the vertebral bodies.Vertebral body = cross-sectional area multiply vertebral body height,volume estimation technique vertebral and vertebral volume in the up and down.Six physicians and hospital PACS system respectively,and select the above mentioned technique vertebral and the narrowest point up and down over the vertebral cross section and measure the vertebral CT value.Total vertebral CT value = vertebral CT value multiply vertebral body volume,which was regarded as the total CT value of vertebral body.Vertebral body height H,cross-sectional area S and volume V of the operative vertebral body and two adjacent vertebral body were measured by six independent doctors.The spearman correlation analysis,single sample t-test and reliability analysis method were used to analyse the results.Results: 1.Spearman correlation analysis was used to analyse the results measured by six doctors,vertebral body height H,cross-sectional area S and volume V of the operative vertebral body and two adjacent vertebral body measured by six doctors were found highly correlated(the correlation coefficient were all above 0.95).2.The reliability data from two doctors(Cronbach alpha coefficient between 0.965-0.994),shows results between six doctor's was found with high reliability.3.Compare the mean CT value ratio of operated vertebra and adjacent fractured vertebra(CT1/CT2)with that of operated vertebra and adjacent vertebra which is not fractured(CT1/CT3),using the single sample t-test statistics,so the total CT value than rather than CT ratio can be used to predict fracture again after PKP significance.Conclusion: 1.When the total CT value ratio of operative vertebral bodies and adjacentvertebral was high,the possibilities of adjacent vertebral got secondary fracture was high.2.The results measures by six doctors were found a high degree of agreement and reliability. |
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