Lenarz Christopher J, Place Howard M
Saint Louis University Hospital, Saint Louis, MO, USA.
J Spinal Disord Tech. 2010 May;23(3):192-6. doi: 10.1097/BSD.0b013e31819e30c1.
The Thoracolumbar Injury Severity Score (TLISS) was introduced as a novel classifications system. Its aim was to simplify classification of thoracolumbar fractures, grade their severity in an ordinal manner as a guide to management. This study attempted to validate the TLISS as a guide to management.
To evaluate the TLISS as a tool for guiding management of thoracolumbar fractures using the outcomes of 97 previously treated spinal fracture.
The TLISS was proposed as a tool for guidance of the management of thoracolumbar fractures to aid the surgeon in choosing management.
Ninety-seven sequential traumatic thoracolumbar fractures were retrospectively reviewed for their management and outcomes. The presenting clinical information had all personal identifiers removed and the fractures were reevaluated by the treating physician using the TLISS. Eighty-one patients had received management that agreed with the suggested management of the TLISS. Nine patients had a score of 4. Seven patients received management that disagreed with the TLISS. Variables affecting the management that differed from the management suggested by the TLISS were identified in each patient and assessed.
Of the 97 patients identified, 81 had received management that agreed with the suggested management of the TLISS. Of the 16 remaining patients, 3 patients scored a 3 or less and received an operation, 1 of which, failed conservative management. Four scored a 5 or more and were managed conservatively, none with known failure. Nine patients scored the ambiguous score of 4. Of these, 4 were managed operatively and 5 nonoperatively.
As a management tool, the TLISS seems to consistently suggest treatment consistent with past treatment recommendations. Multilevel contiguous fractures and extension injuries in the ankylosed thoracic spine appear to be the most consistent exceptions to the TLISS guidelines.
胸腰段损伤严重程度评分（TLISS）作为一种新的分类系统被引入。其目的是简化胸腰段骨折的分类，以序数方式对其严重程度进行分级，作为治疗的指导。本研究试图验证TLISS作为治疗指导的有效性。
利用97例既往治疗的脊柱骨折的结果，评估TLISS作为指导胸腰段骨折治疗的工具。
TLISS被提议作为指导胸腰段骨折治疗的工具，以帮助外科医生选择治疗方法。
回顾性分析97例连续性创伤性胸腰段骨折的治疗及结果。所呈现的临床信息去除了所有个人标识符，治疗医生使用TLISS对骨折进行重新评估。81例患者接受的治疗与TLISS建议的治疗一致。9例患者评分为4分。7例患者接受的治疗与TLISS不一致。确定并评估了每位患者中影响与TLISS建议不同的治疗的变量。
在确定的97例患者中，81例接受的治疗与TLISS建议的治疗一致。在其余16例患者中，3例评分为3分或更低并接受了手术，其中1例保守治疗失败。4例评分为5分或更高并接受了保守治疗，无一例已知失败。9例患者评分为不明确的4分。其中，4例接受了手术治疗，5例接受了非手术治疗。
作为一种治疗工具，TLISS似乎始终如一地建议与过去的治疗建议一致的治疗方法。多节段连续骨折和强直性胸椎的伸展损伤似乎是TLISS指南最一致的例外情况。
