目的建立准确客观判定新鲜/陈旧椎体压缩骨折的方法,降低判定过程中主观因素的影响｡方法 对2013年1月~2014年6月期间的50位经CT及磁共振成像(MRI)检查､确诊为新鲜椎体压缩性骨折患者 (共52个椎体),分别在伤后第30天､90天及180天以上进行三次MRI随诊观察,获取以上4个时间段的观察指标｡统计分析表观弥散系数(ADC)在椎体骨折愈合过程中的变化规律;利用SAS 9.3 统计分析软件建立判别方程,制定新鲜/陈旧椎体压缩骨折的判别方法｡结果 ADC值在椎体骨折愈合过程中呈现逐渐变小并趋向于0的变化趋势,并且在伤后1~13天内､30天､90天､180天以上4个时间段两两比较的结果中,组间差异具有统计学意义,P < 0.05;判别结果为4个时间段的判别方程,判别正确率为71.11%,判别结果为两个时间段(1~13天内与30天以上)的判别方程,判别正确率为92.22%｡结论 ADC值有助于新鲜陈旧椎体压缩骨折的判别｡结果为1~13天内与30天以上的判别方程正确率较高,指标采集方法简单,有利于在法医临床学鉴定工作中推广应用｡

Objective to establish an accurate and objective assay to evaluate the time of fresh and/or old vertebral compression fractures while lowering influence of subjective factors. Methods 50 patients with 52 vertebras were scanned by follow-up MRI three times, on day 30, day 90, and day 180 or more, respectively after the injury. These patients came to the hospital after falling down on the ground within 13 days, and were all diagnosed as vertebral compression fractures without the osteoporosis during January 2013 to June 2014 by CT and MRI. The changes in apparent diffusion coefficient (ADC) values during vertebral fracture healing were statistically analyzed. Formulas were created using SAS 9.3 software according to different parameters. Results ADC values in vertebral fracture healing process decreased gradually and tended to zero. Significant differences between groups (P < 0.05) were observed when comparing mean ADC values of any two of the four periods (1~13 days,30 days, 90 days, 180 days or more after injury). With discriminant equations in these four periods, the accurate rate was 71.11%. However, the discriminant equations for the two periods (1~13 days and 30 days or more) led to the discriminant accuracy up to 92.22%｡ Conclusions ADC could help to identify the fresh or old vertebral compression fractures. With high discriminant accuracy of the equations for 1~13 days and 30 days or more, and the simple index collection, the assessment assay in this paper is conducive to the popularization and application in forensic clinical appraisal.