Рентгенологические и КТ-предикторы повреждения заднего связочного комплекса при переломах тел позвонков грудопоясничного переходного отдела позвоночника: систематический обзор и метаанализ

Цель обзора – по литературным данным выделить наиболее достоверные рентгенологические и КТ-признаки повреждения заднего связочного комплекса (posterior ligamentous complex – PLC) при переломах тел позвонков грудопоясничного переходного отдела позвоночника, изначально трактуемых как тип А по классификации AOSpine. Систематический обзор выполнен согласно рекомендациям PRISMA. В базах данных PubMed, MEDLINE, Cochrane Library обнаружена 491 статья по соответствующей тематике. После реализации критериев включения и исключения для систематического обзора отобрано 7 оригинальных статей из рецензируемых научных журналов за последние 10 лет, 6 из которых вошли в метаанализ. Во всех статьях авторы выделяли по две группы пациентов: с повреждением и без повреждения PLC. Повреждения PLC подтверждали данными МРТ и интраоперационно. Были выделены рентгенологиче-ские и КТ-спондилометрические параметры, которые имели статистически значимые различия между группами. Для определения предикторов повреждения PLC значения этих параметров подвергали регрессионному анализу. После этого провели метаанализ моделей случайных и фиксированных эффектов в зависимости от однородности данных. Оценку статистической гетерогенности проводили с помощью критерия c² с нулевой гипотезой об отсутствии значимых различий во всех исследованиях, а также индекса гетерогенности I². Для графического отображения результатов были построены форест-графики. Локальный кифотический угол более 25°, угол Cobb более 16° и разница межоостистых расстояний более 2,54 мм являются КТ-предикторами повреждения PLC. Параметры, характеризующие межостистые отношения, изучены не более чем в двух исследованиях, но при этом всегда имели статистически значимые отличия между группами с повреждениями и без повреждений PLC, поэтому их нельзя оставлять без внимания при диагностике. Параметры Anterior/posterior vertebral height ratio, Anterior vertebral height ratio, Sagittal index и suprajacent/subjacent не являются предикторами повреждения PLC.

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