Duane Therèse M, Scarcella Nicholas, Cross Justin, Wolfe Luke G, Mayglothling Julie, Aboutanos Michel B, Whelan James F, Malhotra Ajai K, Ivatury Rao R
Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
Am Surg. 2010 Dec;76(12):1351-4.
We hypothesized that flexion extension (FE) films do not facilitate the diagnosis or treatment of ligamentous injury of the cervical spine after blunt trauma. From January 2000 to December 2008 we reviewed all patients who underwent FE films and compared five-view plain films (5 view) and cervical spine CTC with FE in the diagnosis of ligamentous injury. There were 22,929 patients with blunt trauma and of these, 271 patients underwent 303 FE films. Average age was 39.6 years, Injury Severity Score was 10.8, Glasgow Coma Score was 14.1, lactate was 2.6 mmol/L, and hospital length of stay was 6 days. Compared with FE, 5 view and CTC had a sensitivity of 80 per cent (8 of 10), positive predictive value of 47.1 per cent (8 of 17), specificity of 96.55 per cent (252 of 261), and negative predictive value of 99.21 per cent (252 of 254). For purposes of analysis, incomplete and ambiguous FE films were listed as negative; however, 20.5 per cent (62 of 303) were incomplete and 9.2 per cent (28 of 303) were ambiguous. Management did not change for the 2 patients with missed ligament injuries. The 303 studies cost $162,105.00 to obtain. FEs are often incomplete and unreliable making it difficult to use them to base management decisions. They do not facilitate treatment and may lead to increased cost and prolonged cervical collars.
我们假设屈伸（FE）位X线片无助于钝性创伤后颈椎韧带损伤的诊断或治疗。从2000年1月至2008年12月，我们回顾了所有接受FE位X线片检查的患者，并比较了五视图平片（5 view）和颈椎CT三维重建（CTC）在韧带损伤诊断中的应用。共有22929例钝性创伤患者，其中271例患者接受了303次FE位X线片检查。平均年龄为39.6岁，损伤严重度评分（Injury Severity Score）为10.8，格拉斯哥昏迷评分（Glasgow Coma Score）为14.1，乳酸水平为2.6 mmol/L，住院时间为6天。与FE位X线片相比，5视图平片和CTC的敏感度为80%（10例中的8例），阳性预测值为47.1%（17例中的8例），特异度为96.55%（261例中的252例），阴性预测值为99.21%（254例中的252例）。为便于分析，将不完整和不明确的FE位X线片列为阴性；然而，20.5%（303例中的62例）为不完整，9.2%（303例中的28例）为不明确。2例漏诊韧带损伤的患者治疗方案未改变。获取这303项检查花费了162,105.00美元。FE位X线片常常不完整且不可靠，难以据此做出治疗决策。它们无助于治疗，可能导致费用增加和佩戴颈托时间延长。
