胸腰椎骨折分型的发展过程及临床意义
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摘要
随着影像学技术的发展进步、医学知识的推陈出新,胸腰椎骨折分型在过去20年里不断改进,其中Load-sharing、AO和TLICS三种分型在目前临床应用较多。然而现有各分型均存在不同程度的缺陷,如Loadsharing分型未纳入神经功能损伤评估、AO分型太过繁琐、TLICS分型对后方韧带复合体损伤判断可重复性低。临床医生在选择分型时需要能从充分理解到熟练应用,全面评估胸腰椎骨折的损伤机制、神经功能改变、后方韧带复合体的完整性、基于影像学分析的形态学改变及基础疾病情况,从而为患者拟定出最佳的治疗方案。
With the developments of radiological technology and medical knowledge, thoracolumbar classification systems have been constantly improved in the last two decades. Among them, the Load-sharing, AO and TLICS are the popular choices. However, none of the existing thoracolumbar fracture classification systems is fully satisfactory, for instance, the absence of neurological injury evaluation in Load-sharing classification, high complexity of AO classification and low repeatability for estimating the injury of posterior ligamentous complex in TLICS classification. The clinician should better understand and be proficient in use of choosing the classifications. For choosing the best therapeutic regimen for the patients, the clinician should estimate thoroughly the injury mechanism, neurological function, integrity of posterior ligamentous complex, the morphological change based on radiography and the related underlying disease of thoracolumbar fracture.
With the developments of radiological technology and medical knowledge, thoracolumbar classification systems have been constantly improved in the last two decades. Among them, the Load-sharing, AO and TLICS are the popular choices. However, none of the existing thoracolumbar fracture classification systems is fully satisfactory, for instance, the absence of neurological injury evaluation in Load-sharing classification, high complexity of AO classification and low repeatability for estimating the injury of posterior ligamentous complex in TLICS classification. The clinician should better understand and be proficient in use of choosing the classifications. For choosing the best therapeutic regimen for the patients, the clinician should estimate thoroughly the injury mechanism, neurological function, integrity of posterior ligamentous complex, the morphological change based on radiography and the related underlying disease of thoracolumbar fracture.
引文
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[2]AZAM M Q,SADAT-ALI M.The Concept of Evolution of Thoracolumbar Fracture Classifications Helps in Surgical Decisions[J].Asian Spine Journal,2015,9(6):984-994.
[3]龙厚清,李佛保.正确认识胸腰椎骨折分型、合理选择治疗方案[J].中华创伤杂志,2017,33(11):966-969.
[4]KIM B G,DAN J M,SHIN D E.Treatment of thoracolumbar Fracture[J].Asian Spine Journal,2015,9(1):133-146.
[5]曾忠友,张建乔.胸腰椎功能解剖区特点及其治疗方法选择[J].中华创伤杂志,2017,33(6):485-487.
[6]WATSONJONES R.The results of postural reduction of fractures of the spine[J].J-bone Joint Surg am,1938,20(3):567-586.
[7]NICOLL E A.Fractures of the dorso-lumbar spine[J].Journal of Bone&Joint Surg,British volume,1949,31(3):376-394.
[8]HOLDSWORTH F.Fractures,dislocations,and fracturedislocations of the spine[J].Journal of Bone&Joint surgery,American volume,1970,52(8):1534-1551.
[9]DENIS F.The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J].Spine,1983,8(8):817-831.
[10]MCAFEE P C,YUAN H A,FREDRICKSON B E,et al.The value of computed tomography in thoracolumbar fractures.An analysis of one hundred consecutive cases and a new classification[J].Journal of Bone&Joint Surgery,American volume,1983,65(4):461-473.
[11]MCCORMACK T,KARAIKOVIC E,GAINES R W.The load sharing classification of spine fractures[J].Spine,1994,19(15):1741-1744.
[12]WANG H,JIANG J.How to use the load-sharing classification of spine fractures[J].European Spine Journal,2015,24(2):406-407.
[13]MACHINO M,YUKAWA Y,ITO K,et al.Posterior ligamentous complex injuries are related to fracture severity and neurological damage in patients with acute thoracic and lumbar burst fractures[J].Yonsei Medical Journal,2013,54(4):1020-1025.
[14]MAGERL F,AEBI M,GERTZBEIN S D,et al.Acomprehensive classification of thoracic and lumbar injuries[J].European Spine Journal,1994,3(4):184-201.
[15]AEBI M.AO spine classification system for thoracolumbar fractures[J].European Spine Journal,2013,22(10):2147-2148.
[16]ONER F C,RAMOS L M P,SIMMERMACHER R K J,et al.Classification of thoracic and lumbar spine fractures:problems of reproducibility[J].European Spine Journal,2002,11(3):235-245.
[17]VACCARO A R,LEHMAN R A,HURLBERT R J,et al.Anew classification of thoracolumbar injuries:the importance of injury morphology,the integrity of the posterior ligamentous complex,and neurologic status[J].Spine,2005,30(20):2325-2333.
[18]VACCARO A R,LEE J Y,SCHWEITZER K M,et al.Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma[J].Spine Journal,2006,6(5):524-528.
[19]JOAQUIM A F,DE ALMEIDA BASTOS D C,JORGETORRES H H,et al.Thoracolumbar Injury Classification and Injury Severity Score System:A Literature Review of Its Safety[J].Global Spine Journal,2016,6(1):80-85.
[20]郝定均.脊柱损伤的分型[J].中华创伤骨科杂志,2018,20(4):277-279.
[21]钱宇,何磊.正确认识胸腰段脊柱骨折[J].中华创伤杂志,2017,33(6):488-490.
[22]WOOD K B,LI W,LEBL D S,et al.Management of thoracolumbar spine fractures[J].Spine Journal,2014,14(1):145-164.
[2]AZAM M Q,SADAT-ALI M.The Concept of Evolution of Thoracolumbar Fracture Classifications Helps in Surgical Decisions[J].Asian Spine Journal,2015,9(6):984-994.
[3]龙厚清,李佛保.正确认识胸腰椎骨折分型、合理选择治疗方案[J].中华创伤杂志,2017,33(11):966-969.
[4]KIM B G,DAN J M,SHIN D E.Treatment of thoracolumbar Fracture[J].Asian Spine Journal,2015,9(1):133-146.
[5]曾忠友,张建乔.胸腰椎功能解剖区特点及其治疗方法选择[J].中华创伤杂志,2017,33(6):485-487.
[6]WATSONJONES R.The results of postural reduction of fractures of the spine[J].J-bone Joint Surg am,1938,20(3):567-586.
[7]NICOLL E A.Fractures of the dorso-lumbar spine[J].Journal of Bone&Joint Surg,British volume,1949,31(3):376-394.
[8]HOLDSWORTH F.Fractures,dislocations,and fracturedislocations of the spine[J].Journal of Bone&Joint surgery,American volume,1970,52(8):1534-1551.
[9]DENIS F.The three column spine and its significance in the classification of acute thoracolumbar spinal injuries[J].Spine,1983,8(8):817-831.
[10]MCAFEE P C,YUAN H A,FREDRICKSON B E,et al.The value of computed tomography in thoracolumbar fractures.An analysis of one hundred consecutive cases and a new classification[J].Journal of Bone&Joint Surgery,American volume,1983,65(4):461-473.
[11]MCCORMACK T,KARAIKOVIC E,GAINES R W.The load sharing classification of spine fractures[J].Spine,1994,19(15):1741-1744.
[12]WANG H,JIANG J.How to use the load-sharing classification of spine fractures[J].European Spine Journal,2015,24(2):406-407.
[13]MACHINO M,YUKAWA Y,ITO K,et al.Posterior ligamentous complex injuries are related to fracture severity and neurological damage in patients with acute thoracic and lumbar burst fractures[J].Yonsei Medical Journal,2013,54(4):1020-1025.
[14]MAGERL F,AEBI M,GERTZBEIN S D,et al.Acomprehensive classification of thoracic and lumbar injuries[J].European Spine Journal,1994,3(4):184-201.
[15]AEBI M.AO spine classification system for thoracolumbar fractures[J].European Spine Journal,2013,22(10):2147-2148.
[16]ONER F C,RAMOS L M P,SIMMERMACHER R K J,et al.Classification of thoracic and lumbar spine fractures:problems of reproducibility[J].European Spine Journal,2002,11(3):235-245.
[17]VACCARO A R,LEHMAN R A,HURLBERT R J,et al.Anew classification of thoracolumbar injuries:the importance of injury morphology,the integrity of the posterior ligamentous complex,and neurologic status[J].Spine,2005,30(20):2325-2333.
[18]VACCARO A R,LEE J Y,SCHWEITZER K M,et al.Assessment of injury to the posterior ligamentous complex in thoracolumbar spine trauma[J].Spine Journal,2006,6(5):524-528.
[19]JOAQUIM A F,DE ALMEIDA BASTOS D C,JORGETORRES H H,et al.Thoracolumbar Injury Classification and Injury Severity Score System:A Literature Review of Its Safety[J].Global Spine Journal,2016,6(1):80-85.
[20]郝定均.脊柱损伤的分型[J].中华创伤骨科杂志,2018,20(4):277-279.
[21]钱宇,何磊.正确认识胸腰段脊柱骨折[J].中华创伤杂志,2017,33(6):488-490.
[22]WOOD K B,LI W,LEBL D S,et al.Management of thoracolumbar spine fractures[J].Spine Journal,2014,14(1):145-164.