Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA.
Spine J. 2012 Jul;12(7):612-28. doi: 10.1016/j.spinee.2012.01.009.
The optimal classification and treatment algorithm for complex lumbosacral injuries, in particular high-energy sacral fractures and lumbosacral dissociation (LSD) injuries, remains controversial. Currently used classification systems are largely descriptive, lacking validity, reproducibility, treatment considerations, and prognostic information.
We set out to develop a comprehensive, yet practical, classification system for complex lumbosacral injuries that assists in clinical decision making.
We developed a new classification system for complex lumbosacral injuries derived through literature review, expert opinion, and our clinical experience treating combat casualties over the past 10 years. We have seen an increased incidence of complex sacral fractures and LSD injuries after high-energy blast trauma, motor vehicle collisions, and aircraft crashes.
We performed an extensive literature review and discussed the proposed classification with spinal trauma surgeons from a variety of institutions familiar with the treatment of complex high-energy sacral fractures and LSD injuries. We identified the significant clinical and radiographic variables encountered in the decision-making process for the treatment of complex lumbosacral injuries. Existing classification systems were reviewed in light of these essential characteristics, and their limitations were defined and addressed with the new system.
A new classification system called lumbosacral injury classification system (LSICS) was devised based on three injury characteristics: injury morphology, posterior ligamentous complex integrity, and neurologic status. A composite injury severity score was calculated by summing a weighted score from each category, allowing patients to be stratified into surgical and nonsurgical treatment groups based on threshold values. Modifiers to determining appropriate selection for operative treatment include systemic injury load and physiological status of the polytraumatized patient, soft-tissue status, and expected time to mobility. Finally, an algorithm was developed to determine the optimum operative technique based on the previously outlined injury characteristics.
The LSICS provides a comprehensive and practical approach for evaluating injury severity and guiding clinical decision making. This system provides common language for surgeons to communicate various injury patterns and formulate treatment modalities. Further studies are necessary to determine the reliability and validity of this new classification system.
对于复杂腰骶部损伤，特别是高能骶骨骨折和腰骶部分离（LSD）损伤，最佳的分类和治疗方案仍存在争议。目前使用的分类系统主要是描述性的，缺乏有效性、可重复性、治疗考虑因素和预后信息。
我们旨在开发一种全面而实用的复杂腰骶部损伤分类系统，以协助临床决策。
我们通过文献回顾、专家意见和过去 10 年治疗战斗伤员的临床经验，开发了一种新的复杂腰骶部损伤分类系统。我们已经看到高能爆炸伤、机动车事故和飞机失事导致复杂骶骨骨折和 LSD 损伤的发生率增加。
我们进行了广泛的文献回顾，并与来自不同机构的熟悉治疗复杂高能骶骨骨折和 LSD 损伤的脊柱创伤外科医生讨论了提出的分类。我们确定了在治疗复杂腰骶部损伤的决策过程中遇到的重要临床和影像学变量。根据这些基本特征，对现有的分类系统进行了审查，并针对新系统定义和解决了其局限性。
根据损伤形态、后韧带复合体完整性和神经状态这三个损伤特征，设计了一种新的分类系统，称为腰骶部损伤分类系统（LSICS）。通过从每个类别中汇总加权分数来计算综合损伤严重程度评分，允许根据阈值将患者分为手术和非手术治疗组。确定手术治疗选择的修正因素包括全身损伤负荷和多发伤患者的生理状态、软组织状况以及预期的活动时间。最后，根据前面概述的损伤特征制定了确定最佳手术技术的算法。
LSICS 为评估损伤严重程度和指导临床决策提供了一种全面而实用的方法。该系统为外科医生提供了一种通用语言，用于交流各种损伤模式并制定治疗方案。需要进一步研究来确定这个新分类系统的可靠性和有效性。
