Trauma and Emergency Surgery Program, University of California Davis Medical Center, 2315 Stockton Boulevard Ste 4212, Sacramento, CA 95817, USA.
Eur Spine J. 2013 Jul;22(7):1467-73. doi: 10.1007/s00586-012-2598-z. Epub 2013 Feb 13.
Flexion and extension radiographs are often used in the setting of trauma to clear a cervical spine injury. The utility of such tests, however, remains to be determined. We hypothesized that in patients who underwent a negative computed tomography (CT) cervical spine scan, flexion and extension radiographs did not yield useful additional information.
We conducted a retrospective chart review of all patients admitted to a Level I trauma center who had a negative CT scan of the cervical spine and a subsequent cervical flexion-extension study for evaluation of potential cervical spine injury. All flexion-extension films were independently reviewed to determine adequacy as defined by C7/T1 visualization and 30° of change in the angle from flexion to extension. The independent reviews were compared to formal radiology readings and the influence of the flexion-extension studies on clinical decision making was also reviewed.
One thousand patients met inclusion criteria for the study. Review of the flexion-extension radiographs revealed that 80% of the films either did not adequately demonstrate the C7/T1 junction or had less than 30° range of motion. There was one missed injury that was also missed on magnetic resonance imaging. Results of the flexion-extension views had minimal effects on clinical decision making.
Adequate flexion extension films are difficult to obtain and are minimally helpful for clearance of the cervical spine in awake and alert trauma patients.
在创伤情况下，通常会使用屈伸位 X 光片来排除颈椎损伤。然而，这些检查的效用仍有待确定。我们假设，在接受过阴性颈椎计算机断层扫描（CT）的患者中，屈伸位 X 光片不会提供有用的额外信息。
我们对所有收入一级创伤中心、颈椎 CT 扫描阴性且随后进行颈椎屈伸位研究以评估潜在颈椎损伤的患者进行了回顾性图表审查。所有屈伸位 X 光片均由独立的观察者进行评估，以确定 C7/T1 可视化和从屈曲到伸展角度变化 30°的标准来评估其充分性。独立评估与正式放射学阅读进行了比较，还审查了屈伸位研究对临床决策的影响。
1000 名患者符合本研究的纳入标准。对屈伸位 X 光片的评估显示，80%的 X 光片要么不能充分显示 C7/T1 交界处，要么活动度小于 30°。有一个漏诊的损伤也在磁共振成像中漏诊了。屈伸位 X 光片的结果对临床决策的影响很小。
在清醒和警觉的创伤患者中，获得充分的屈伸位 X 光片具有一定难度，且对颈椎的清除作用不大。
