PURPOSE:The diagnostic assessment and prognostic value of the posterior ligamentous complex (PLC) remains a controversial topic in the management of patients with thoracolumbar spinal injury. The purpose of this review was to critically appraise the literature and present an overview of the: (1) precision, (2) accuracy, and (3) validity of detecting PLC injuries in patients with thoracic and lumbar spine trauma. METHODS:Studies evaluating the precision, accuracy and/or validity of detecting and managing PLC injuries in patients with thoracic and/or lumbar spine injuries were searched through the Medline database (1966 to September 2011). References were retrieved and evaluated individually and independently by two authors. RESULTS:Twenty-one eligible studies were identified. Few studies reported the use of countermeasures for sampling and measurement bias. In nine agreement studies, the PLC was assessed in various ways, ranging from use of booklets to a complete set of diagnostic imaging. Inter-rater and intra-rater kappa values ranged from 0.188 to 0.915 and 0.455 to 0.840, respectively. In nine accuracy studies, magnetic resonance (MR) imaging was most often (n = 6) compared with intra-operative findings. In general, MR imaging tended to demonstrate relatively high negative predictive values and relatively low positive predictive values for PLC injuries. CONCLUSIONS:A wide variety of methods have been applied in the evaluation of precision and accuracy of PLC injury detection, leaving spinal surgeons with a multitude of variable results. There is scant clinical evidence demonstrating the true prognostic value of detected PLC injuries in patients with thoracic and lumbar spine injuries. We recommend the conduct of longitudinal clinical follow-up studies on those cases assessed for precision and/or accuracy of PLC injuries.

译文

目的:后韧带复合体(PLC)的诊断评估和预后价值在胸腰椎脊柱损伤患者的治疗中仍然是一个有争议的话题。这篇综述的目的是对文献进行严格的评估,并对以下方面进行概述:(1)准确性,(2)准确性和(3)在胸椎和腰椎创伤患者中检测PLC损伤的有效性。
方法:通过Medline数据库(1966年至2011年9月),对评估对胸椎和/或腰椎损伤患者进行PLC损伤检测和处理的准确性,准确性和/或有效性进行评估的研究。两位作者分别和独立检索和评价了参考文献。
结果:鉴定出二十一项符合条件的研究。很少有研究报告对抽样和测量偏差使用对策。在九项协议研究中,以各种方式对PLC进行了评估,从使用手册到完整的诊断成像。评定者间和评定者内kappa值的范围分别为0.188至0.915和0.455至0.840。在9项准确性研究中,与术中发现相比,磁共振(MR)成像频率最高​​(n = 6)。通常,MR成像倾向于表现出相对较高的PLC损伤阴性预测值和相对较低的阳性预测值。
结论:各种各样的方法已被用于PLC损伤检测的准确性和准确性的评估,使脊柱外科医师具有多种多样的结果。几乎没有临床证据证明所检测到的PLC损伤对胸椎和腰椎损伤患者具有真正的预后价值。我们建议对那些评估PLC损伤的准确性和/或准确性的病例进行纵向临床随访研究。

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