Significance Of MRI Classification Of Thoracolumbar Osteoporotic Fractures In Guiding PVP

Objective:（1）A new classification of vertebral osteoporotic fractures is designed according to the characteristics of MRI-STIR sequence and to evaluate the interobserver reliability and intraobserver reproducibility.（2）According to the classification,the technique of vertebroplasty is improved,and the effectiveness of the operation method is evaluated.Method:（1）One hundred patients with thoracolumbar osteoporotic fractures diagnosed and treated in our hospital from June 2019 to September 2020 were analyzed retrospectively.All patients underwent MRI、CT and Xray.Based on MRI-STIR midsagittal sequence of vertebral body,classification are divided into five categories according to the distribution position of high signal in vertebral body.After receiving unified and standardized training,four spine surgeons with different seniority classified the imaging of patients according to this classification method,and evaluated evaluate the interobserver reliability and intraobserver reproducibility.（2）twenty-three patients with acute vertebral osteoporotic fractures who underwent modified vertebroplasty in our department from November2019 to September 2021 were analyzed retrospectively,and were followed up for at least 3 months.Visual analogue scale（VAS）was mainly used to evaluate the clinical effect,and the imaging results were evaluated according to the change of preoperative and postoperative vertebral height.Results:（1）The osteoporotic fracture classification is provided below.Type Ⅰ: the location of high signal is distributed in the whole vertebral body;Type Ⅱ:high signal is mainly distributed in the upper endplate area;Type Ⅲ: high signal is mainly distributed in the lower endplate area;Type Ⅳ: obvious linear high signal shadow in the vertebral body;Type Ⅴ: the signal distribution in the vertebral body is patchy.The overall kappa coefficient of interobserver reliability is 0.794,which represents high reliability.The kappa coefficients of each subtype are as follows: type Ⅰ is 0.616,which represents high reliability;Type Ⅱ is 0.518,which represents medium reliability;Type Ⅲ is 0.747,which represents high reliability;Type Ⅳ was0.694,which represents high reliability;The Ⅴ-type is 0.509,which represents medium reliability.The kappa coefficient of interobserver repeatability is as follows: doctor 1 is 0.839;Doctor 2 was 0.811;Doctor 3was 0.774;Doctor 4 was 0.789.All have high reproducibility.（2）When compared preoperative vertebral high with postoperative,there are significant difference.Comparison of preoperative and postoperative VAS score showed significant difference.There was no significant difference in VAS scores when compared immediately after operation with 1 month and3 months after operation.There was no significant difference in VAS score when compared 1 month with 3 months after operation.Conclusions:（1）The classification of vertebral osteoporotic fracture has high reliability in methodology and interobserver reliability and intraobserve reproducibility are high,indicating that the classification is simple,stable,easy to master and conducive to popularization.（2）This classification can effectively guide the treatment of improved vertebroplasty.The operation has good clinical effect and can be applied.