下颈椎损伤分型临床应用的可靠性与有效性的评价

目的 评价脊柱创伤研究小组(STSG)提出的下颈椎损伤分型(SLIC)临床应用的可靠性和有效性。方法 选取2006年6月至2009年6月收治的30例下颈椎外伤患者，其中男24例，女6例；年龄31 ～74岁，平均54.4岁。损伤节段：C3/42例，C4/56例，C5/67例，C6/74例，C3-53例，C4-66例，C3-62例。30例患者中8例行非手术治疗，22例行手术治疗。根据SLIC系统进行评分，该系统主要以损伤形态、椎间盘韧带复合体(DLC)的完整性及神经功能状态3个成分为基础。使用组间相关系数(ICC)评价SLIC临床应用的可靠性，使用Cohen's Kappa评价SLIC指导治疗的有效性。结果 损伤形态观察者间信度优(ICC =0.68)，DLC完整性观察者间信度良好(ICC =0.51)，神经功能状态观察者间信度特优(ICC=0.83)，SLIC总得分观察者间信度优(ICC=0.78)。SLIC推荐治疗方案和实际治疗方案达到86.7％的一致性(Kappa =0.706)。若排除得分3～5分的患者，SLIC推荐治疗方案和实际治疗方案达到92.9％的一致性(Kappa =0.837)。结论 SLIC简单、标准、可靠性强，能有效地指导临床治疗。

Reliability and validity of sub-axial injury classification in clinical application

Objective To evaluate the clinical reliability and validity of the sub-axial injury classification(SLIC) system proposed by the Spine Trauma Study Group(STSG) in 2007.Methods Thirty cases of cervical injury were randomly chosen from the patients treated in our department from June 2006 to June 2009. Eight spine surgeons scored them according to the SLIC system respectively. Interclass correlation coefficient (ICC) was used to assess the reliability of SLIC, and Cohen's Kappa was employed to evaluate its validity.ResultsGood inter-observer agreement was demonstrated in injury morphology (ICC =0. 68),and moderate inter-observer agreement in disco-ligamentous complex (DLC) (ICC = 0. 51 ). The inter-observer evaluation of neurologic status proved to be the most reliable with an ICC of 0. 83, and the inter-observer agreement in total SLIC score was excellent with an ICC of 0. 78. The SLIC score algorithms agreed with the actual treatments in 86.7％ of cases (Kappa =0. 706). The agreement rose to 92.9％ (Kappa =0. 837), if the cases for which a definitive recommendation was not made (average SLIC score, 3 to 5) were excluded.Conclusion SLIC is a simple, reliable, and effective adjunct in clinical decision-making for the treatment of lower cervical spine injuries.