Whang Peter G, Vaccaro Alexander R, Poelstra Kornelius A, Patel Alpesh A, Anderson D Greg, Albert Todd J, Hilibrand Alan S, Harrop James S, Sharan Ashwini D, Ratliff John K, Hurlbert R John, Anderson Paul, Aarabi Bizhan, Sekhon Lali H S, Gahr Ralf, Carrino John A
Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA 19107, USA.
Spine (Phila Pa 1976). 2007 Apr 1;32(7):791-5. doi: 10.1097/01.brs.0000258882.96011.47.
The Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) were prospectively evaluated.
To compare the reliability and validity of the TLISS and TLICS schemes to determine the importance of injury mechanism and morphology to the identification and treatment of thoracolumbar fractures.
Two novel algorithms have been developed for the categorization and management of thoracolumbar injuries: the TLISS system emphasizing injury mechanism and the TLICS scheme involving injury morphology.
The clinical and radiographic findings of 25 patients with thoracolumbar fractures were prospectively presented to 5 groups of surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored, first using the TLISS and then 3 months later with the TLICS. The recommended treatments proposed by the 2 schemes were compared with the actual management of each patient.
For both algorithms, the interrater kappa statistics of all subgroups (mechanism/morphology, status of the posterior ligaments, total score, predicted management) were within the range of moderate to substantial reproducibility (0.45-0.74), and there were no statistically significant differences noted between the respective kappa values. Interrater correlation was higher for the TLISS paradigm on mechanism/morphology, integrity of the posterior ligaments, and proposed management (P < or = 0.01). The TLISS and TLICS schemes both exhibited excellent overall validity.
Although both schemes were noted to have substantial reproducibility and validity, our results indicate the TLISS is more reliable than the TLICS, suggesting that the mechanism of trauma may be a more valuable parameter than fracture morphology for the classification and treatment thoracolumbar injuries. Since these injury characteristics are interrelated and are critical to the maintenance of spinal stability, we think that both concepts should be considered during the assessment and management of these patients.
对胸腰段损伤严重程度评分（TLISS）和胸腰段损伤分类及严重程度评分（TLICS）进行前瞻性评估。
比较TLISS和TLICS方案的可靠性和有效性，以确定损伤机制和形态对胸腰段骨折识别及治疗的重要性。
已开发出两种用于胸腰段损伤分类和管理的新算法：强调损伤机制的TLISS系统和涉及损伤形态的TLICS方案。
将25例胸腰段骨折患者的临床和影像学检查结果前瞻性地呈现给5组在脊柱创伤方面训练水平和经验不同的外科医生。对这些损伤连续进行评分，首先使用TLISS评分，然后在3个月后使用TLICS评分。将这两种方案建议的治疗方法与每位患者的实际治疗情况进行比较。
对于这两种算法，所有亚组（机制/形态、后韧带状态、总分、预测治疗）的评分者间kappa统计值均在中度至高度可重复性范围内（0.45 - 0.74），且各kappa值之间无统计学显著差异。在机制/形态、后韧带完整性和建议治疗方面，TLISS模式的评分者间相关性更高（P≤0.01）。TLISS和TLICS方案均表现出出色的总体有效性。
虽然两种方案都具有较高的可重复性和有效性，但我们的结果表明TLISS比TLICS更可靠，这表明对于胸腰段损伤的分类和治疗，创伤机制可能是比骨折形态更有价值的参数。由于这些损伤特征相互关联且对维持脊柱稳定性至关重要，我们认为在对这些患者进行评估和治疗时应同时考虑这两个概念。
