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Войти в исследования Skeletal radiology · 2025
Lumbosacral plexus and sciatic nerve injury following acetabular fracture: predictive value of CT bony features and perineural hematoma.
СтатьяНазвание и аннотация: Перевод в очереди
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Vigna Keithan, Sertic Andrew, Robinson Larry, Lin Bin, Sivakumaran Thiru
Аннотация
OBJECTIVE: Sciatic nerve injury is a rare, devastating complication of acetabular fracture.
PURPOSE: assess CT predictive value (bony features and perineural hematoma) for sciatic nerve injury following acetabular fracture.
MATERIALS AND METHODS: IRB-approved retrospective study (n = 471) from 2011 to 2022. Single rater evaluated each case for Judet-Letournel subtype, joint congruence loss, and posterior displacement. Three raters assessed perineural hematoma in zones 1-3: obturator internus, piriformis, and posterior thigh. EMG/NCS confirmed sciatic injury in 20 cases. Sensitivity, specificity, PPV, NPV, OR, and accuracy (AUC) were computed for each marker. Intra- and inter-rater reliability was calculated.
RESULTS: Sciatic injury was most frequent in associated both column (8.0%) and transverse family (5.9%) fractures. Sensitivity and specificity of fracture features on sciatic injury were both column involvement (0.85 [17/20], 0.31 [140/451]), congruence loss (0.90 [18/20], 0.36 [163/451]), and posterior displacement (0.70 [14/20], 0.54 [244/451]). Joint congruence loss (OR 5.08, p = 0.016) and posteriorly displaced fragment (OR = 2.74, p = 0.04) were statistically significant (p < 0.05). For hematoma, sensitivity and specificity were zone 1, 0.65-0.80 [13/20-16/20] and 0.30-0.36 [136/451-161/451]; zone 2, 0.60-0.80 [12/20-16/20] and 0.39-0.57 [176/451-255/451]; and zone 3, 0.15-0.25 [3/20-5/20] and 0.69-0.86 [312/451-388/451]. AUC values were zone 1, 0.65-0.71 (satisfactory-to-good); zone 2, 0.69-0.71; and zone 3, 0.48-0.61 (poor-to-satisfactory). Values were significant in zones 1 and 2. Intra-rater reliability (Gwet's AC2) was almost perfect in zone 1 (0.86-0.87), moderate to almost perfect in zones 2-3 (0.47-0.90). Inter-rater agreement (Gwet's AC2) in zones 1-3 was 0.73 (substantial), 0.49 (moderate), and 0.50.
CONCLUSION: We found three statistically significant predictors of sciatic nerve injury following acetabular fracture: joint congruence loss, posteriorly displaced bone fragment, and perineural hematoma at the level of (a) obturator internus and (b) piriformis. Rater agreement for perineural hematoma was excellent for zone 1.
PURPOSE: assess CT predictive value (bony features and perineural hematoma) for sciatic nerve injury following acetabular fracture.
MATERIALS AND METHODS: IRB-approved retrospective study (n = 471) from 2011 to 2022. Single rater evaluated each case for Judet-Letournel subtype, joint congruence loss, and posterior displacement. Three raters assessed perineural hematoma in zones 1-3: obturator internus, piriformis, and posterior thigh. EMG/NCS confirmed sciatic injury in 20 cases. Sensitivity, specificity, PPV, NPV, OR, and accuracy (AUC) were computed for each marker. Intra- and inter-rater reliability was calculated.
RESULTS: Sciatic injury was most frequent in associated both column (8.0%) and transverse family (5.9%) fractures. Sensitivity and specificity of fracture features on sciatic injury were both column involvement (0.85 [17/20], 0.31 [140/451]), congruence loss (0.90 [18/20], 0.36 [163/451]), and posterior displacement (0.70 [14/20], 0.54 [244/451]). Joint congruence loss (OR 5.08, p = 0.016) and posteriorly displaced fragment (OR = 2.74, p = 0.04) were statistically significant (p < 0.05). For hematoma, sensitivity and specificity were zone 1, 0.65-0.80 [13/20-16/20] and 0.30-0.36 [136/451-161/451]; zone 2, 0.60-0.80 [12/20-16/20] and 0.39-0.57 [176/451-255/451]; and zone 3, 0.15-0.25 [3/20-5/20] and 0.69-0.86 [312/451-388/451]. AUC values were zone 1, 0.65-0.71 (satisfactory-to-good); zone 2, 0.69-0.71; and zone 3, 0.48-0.61 (poor-to-satisfactory). Values were significant in zones 1 and 2. Intra-rater reliability (Gwet's AC2) was almost perfect in zone 1 (0.86-0.87), moderate to almost perfect in zones 2-3 (0.47-0.90). Inter-rater agreement (Gwet's AC2) in zones 1-3 was 0.73 (substantial), 0.49 (moderate), and 0.50.
CONCLUSION: We found three statistically significant predictors of sciatic nerve injury following acetabular fracture: joint congruence loss, posteriorly displaced bone fragment, and perineural hematoma at the level of (a) obturator internus and (b) piriformis. Rater agreement for perineural hematoma was excellent for zone 1.