摘要
目的评估下颈椎损伤分类（subaxial cervical spine injury classification，SLIC）系统的可信度和可重复性及其对颈脊柱脊髓损伤治疗的指导作用。方法选择2007年12月-2008年7月入院的下颈椎脊柱脊髓损患者30例，均行颈椎X线、CT、MRI检查和系统的神经学体检，按照SLIC系统的原则从三个方面对其进行评估，即骨折的形态、间盘韧带复合体（disco—ligamentous complex，DLC）状态和神经功能状态。根据影像学检查将骨折形态分为：无损伤、压缩型、爆裂型、牵张型和旋转／平移型；将DLC损伤分为：无损伤型、不确定型、断裂型。根据神经学体检将神经损伤状态分为：无损伤、神经根损伤、完全性／不完全性脊髓损伤和持续脊髓压迫。分四组医师根据SLIC系统对30例患者资料进行评定，计算SLIC评分，并根据评分决定其治疗方案。3个月后进行再次评估。使用Cohen加权Kappa系数对SLIC总分、骨折形态、DLC状态、神经损伤状态、治疗选择进行观察者间一致性和可重复性分析。根据SLIC评分选择治疗方法，评估此组患者的神经功能恢复情况和并发症发生情况。结果计算SLIC亚类（骨折形态、DLC状态、SLIC总分、治疗选择）的Kappa系数位于中度和较高可信度之间（0．47～0．69），针对神经损伤状态亚类的Kappa系数为0．83，可信度高，诊断一致性较高。两次可信度评估的Kappa值差异无统计学意义。以相同方法计算SLIC系统可重复性，SLIC亚类（骨折形态、DLC状态、SLIC总分、治疗推荐）的Kappa系数位于中度和较高可重复性之间（0．53～0．78），针对神经损伤状态亚类的Kappa系数为0．89，为高度可重复性。根据SLIC评分选择治疗，神经功能恢复率为79．2％，此组患者治疗后无神经损伤加重，并发症发生率较低。结论SLIC系统具有较高的可靠性和可重复性，且使用简单，易于掌握，此方
Objective To evaluate the interobserver reliability and intraobserver reproducibility of the subaxial cervical spine injury classification system （ SLIC ） and identify its guidance on clinical treatment of spinal cord injuries. Methods Thirty consecutive patients with subaxial cervical injury admitted into our hospital between December 2007 and July 2008 were enrolled in this study and underwent neurological examinations followed by X-ray, CT, and MRI examinations. SLIC was evaluated in aspects of fracture morphology, disco-ligamentous complex （DLC） status and neurologie status. According to the morphology in image, the fractures were classified into normal, compression, burst, distraction and translation/rotation. According to injury severity, DLC was sorted into intact, indeterminate and disrupted types. Neurologic status was classified into intact, nerve root injury, complete/incomplete spinal cord injury and continuous spinal cord compression. The clinical and radiographic data of 30 patients with subaxial cervical injury were evaluated prospectively by four groups of surgeons to count SLIC scores and decide treatment based on SLIC scores. The evaluation was done again three months later. Cohen＇ s unweighted kappa coefficients were calculated for the key parameters of each classification system （ morphology, neurologic status, DLCstatus, total score, and proposed management） to analyze the reliability and reproducibility of SLIC. Based on SLIC, the treatment method was selected and the neurological function recovery and the complications observed. Results The interrater Kappa statistics of all subgroups （ morphology, DLCstatus, total score, proposed management） were within the range of moderate to substantial reliability （0.47-0.69）. Kappa coefficient was 0.83 for neurologic status, with high reliability. There was no statistical difference upon Kappa values in two evaluations. The interrater Kappa statistics of all subgroups （morphology, DLCstatus, total score, proposed management）
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2009年第5期403-407,共5页
Chinese Journal of Trauma
基金
全军“十一五”科技攻关课题资助项目（06G028）
首都医学发展基金资助项目（2005-20167）
关键词
脊柱损伤
颈椎
诊断显像
分类系统
Spinal iniuries
Cervical vertebrae
Diagnostic imaging
Classification system
