Vaccaro Alexander R, Hulbert R John, Patel Alpesh A, Fisher Charles, Dvorak Marcel, Lehman Ronald A, Anderson Paul, Harrop James, Oner F C, Arnold Paul, Fehlings Michael, Hedlund Rune, Madrazo Ignacio, Rechtine Glenn, Aarabi Bizhan, Shainline Mike
Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Spine (Phila Pa 1976). 2007 Oct 1;32(21):2365-74. doi: 10.1097/BRS.0b013e3181557b92.
The classification system was derived through a literature review and expert opinion of experienced spine surgeons. In addition, a multicenter reliability and validity study of the system was conducted on a collection of trauma cases.
To define a novel classification system for subaxial cervical spine trauma that conveys information about injury pattern, severity, treatment considerations, and prognosis. To evaluate reliability and validity of this system.
Classification of subaxial cervical spine injuries remains largely descriptive, lacking standardization and prognostic information.
Clinical and radiographic variables encountered in subaxial cervical trauma were identified by a working section of the Spine Trauma Study Group. Significant limitations of existing systems were defined and addressed within the new system. This system, as well as the Harris and Ferguson & Allen systems, was applied by 20 spine surgeons to 11 cervical trauma cases. Six weeks later, the cases were randomly reordered and again scored. Interrater reliability, intrarater reliability, and validity were assessed.
Each of 3 main categories (injury morphology, disco-ligamentous complex, and neurologic status) identified as integrally important to injury classification was assigned a weighted score; the injury severity score was obtained by summing the scores from each category. Treatment options were assigned based on threshold values of the severity score. Interrater agreement as assessed by intraclass correlation coefficient of the DLC, morphology, and neurologic status scores was 0.49, 0.57, and 0.87, respectively. Intrarater agreement as assessed by intraclass correlation coefficient of the DLC, morphology, and neurologic status scores was 0.66, 0.75, and 0.90, respectively. Raters agreed with treatment recommendations of the algorithm in 93.3% of cases, suggesting high construct validity. The reliability compared favorably to the Harris and Ferguson & Allen systems.
The Sub-axial Injury Classification and Severity Scale provides a comprehensive classification system for subaxial cervical trauma. Early validity and reliability data are encouraging.
该分类系统是通过对文献的回顾以及经验丰富的脊柱外科医生的专家意见得出的。此外，还对一系列创伤病例进行了该系统的多中心可靠性和有效性研究。
定义一种用于下颈椎创伤的新型分类系统，该系统能够传达有关损伤模式、严重程度、治疗考虑因素和预后的信息。评估该系统的可靠性和有效性。
下颈椎损伤的分类在很大程度上仍属描述性，缺乏标准化和预后信息。
脊柱创伤研究小组的一个工作部门确定了下颈椎创伤中遇到的临床和影像学变量。在新系统中界定并解决了现有系统的重大局限性。20位脊柱外科医生将该系统以及哈里斯系统和弗格森与艾伦系统应用于11例颈椎创伤病例。六周后，对病例进行随机重新排序并再次评分。评估了评分者间信度、评分者内信度和效度。
确定对损伤分类至关重要的3个主要类别（损伤形态、椎间盘韧带复合体和神经学状态）中的每一个都被赋予一个加权分数；损伤严重程度评分通过将每个类别的分数相加得出。根据严重程度评分的阈值分配治疗方案。通过类内相关系数评估的椎间盘韧带复合体、形态和神经学状态评分的评分者间一致性分别为0.49、0.57和0.87。通过类内相关系数评估的椎间盘韧带复合体、形态和神经学状态评分的评分者内一致性分别为0.66、0.75和0.90。评分者在93.3%的病例中同意该算法的治疗建议，表明具有较高的结构效度。其可靠性优于哈里斯系统和弗格森与艾伦系统。
下颈椎损伤分类及严重程度量表为下颈椎创伤提供了一个全面的分类系统。早期的效度和信度数据令人鼓舞。
