Department of Orthopaedic Surgery, University of California-Davis, 4860 Y Street, Sacramento, CA 95817, USA.
J Orthop Trauma. 2011 Jan;25(1):51-6. doi: 10.1097/BOT.0b013e3181dc54bf.
To investigate the usefulness of flexion and extension radiographs of the cervical spine as a screening tool for the acute evaluation of ligamentous injury in cases of awake blunt trauma in patients with a negative cervical computed tomography scan.
Retrospective study of consecutive patient series.
Level I trauma center.
All patients admitted to an academic Level I trauma center over 12 months who sustained a blunt force injury and underwent flexion-extension radiography during hospitalization.
The flexion-extension radiographs were interpreted for adequacy and pathology by two independent reviewers who were blinded to patient outcome and the original radiologic interpretation. Adequacy of radiographs was assessed using four criteria: 1) complete visualization of the cervical spine from the occiput to the superior end plate of the first thoracic vertebra; 2) adequate range of flexion and extension was defined as motion greater than 30° from the neutral position; 3) supplementation with a swimmer's view if the cervicothoracic junction was poorly visualized; and 4) no evidence of rotational deformity on neutral, flexion, or extension views. Radiographs were thus deemed either "adequate" or "inadequate." Acute instability was defined as listhesis of greater than 3.5 mm or 11° of relative angulation. Radiologists' interpretation of all studies was noted and any clinical or radiographic evidence of instability on follow-up within 3 months of discharge was also recorded.
A total of 311 patients were included in the study. The intraobserver reliability for the four fixed criteria for adequacy of flexion and extension radiographs was excellent. Only 97 (31%) flexion and extension radiographs were deemed adequate. Two hundred fourteen (69%) patient radiographs were deemed inadequate but were interpreted as normal by the radiologists. Not a single radiograph was identified with evidence of acute instability (true-positive = 0). One hundred seventy-one (55%) of patients had follow-up within 3 months of discharge from the hospital of which one (0.5%) patient developed signs of instability necessitating surgery. The sensitivity was 0%, specificity 99%, positive predictive value 0%, and negative predictive value 31%.
Flexion and extension radiographs do not appear to be clinically useful in assessing acute instability in patients hospitalized with blunt trauma with negative computed tomography scans.
探讨颈椎屈伸位 X 线片在清醒状态下钝性创伤患者中，对颈椎计算机断层扫描（CT）阴性患者的韧带损伤进行急性评估的筛查作用。
连续患者系列的回顾性研究。
一级创伤中心。
12 个月内在学术一级创伤中心住院的所有钝性损伤患者，在住院期间接受颈椎屈伸位 X 线片检查。
两名独立的观察者对屈伸位 X 线片进行充分性和病理评估，观察者对患者的结局和原始影像学解释均不知情。通过四个标准评估 X 线片的充分性：1）从枕骨到第一胸椎上终板完整显示颈椎；2）屈伸范围充足定义为从中立位移动超过 30°；3）如果颈椎与胸段交界处显示不佳，补充泳者位；4）中立位、屈伸位无旋转畸形。X 线片因此被认为是“充分”或“不充分”。急性不稳定定义为移位大于 3.5mm 或相对成角 11°。记录放射科医生对所有研究的解释，以及在出院后 3 个月内随访时任何临床或影像学不稳定的证据。
共有 311 例患者纳入研究。评估颈椎屈伸位 X 线片充分性的 4 项固定标准的观察者内可靠性极好。只有 97 例（31%）屈伸位 X 线片被认为是充分的。214 例（69%）患者的 X 线片被认为不充分，但放射科医生的解释为正常。没有一张 X 线片显示出急性不稳定的证据（真阳性=0）。171 例（55%）患者在出院后 3 个月内进行了随访，其中 1 例（0.5%）患者出现需要手术的不稳定迹象。敏感度为 0%，特异性 99%，阳性预测值 0%，阴性预测值 31%。
对于 CT 扫描阴性的钝性创伤住院患者，屈伸位 X 线片似乎在评估急性不稳定方面没有临床价值。
