*Thomas Jefferson University and The Rothman Institute, Philadelphia, PA †University Medical Center, Utrecht, the Netherlands ‡Vancouver General Hospital, Vancouver, British Columbia, Canada §Unfallklinik Frankfurt am Main, Frankfurt, Germany ¶University of Washington, Seattle, WA ‖Medical University Innsbruck, Innsbruck, Austria **University of Maryland School of Medicine, Baltimore, MD ††Harborview Medical Center, Seattle, WA ‡‡Ganga Hospital, Coimbatore, Tamil Nadu, India §§University of Toronto, Toronto, Ontario, Canada; and ¶¶Catholic University, Curitiba, Brazil.
Spine (Phila Pa 1976). 2013 Nov 1;38(23):2028-37. doi: 10.1097/BRS.0b013e3182a8a381.
Reliability and agreement study, retrospective case series.
To develop a widely accepted, comprehensive yet simple classification system with clinically acceptable intra- and interobserver reliability for use in both clinical practice and research.
Although the Magerl classification and thoracolumbar injury classification system (TLICS) are both well-known schemes to describe thoracolumbar (TL) fractures, no TL injury classification system has achieved universal international adoption. This lack of consensus limits communication between clinicians and researchers complicating the study of these injuries and the development of treatment algorithms.
A simple and reproducible classification system of TL injuries was developed using a structured international consensus process. This classification system consists of a morphologic classification of the fracture, a grading system for the neurological status, and description of relevant patient-specific modifiers. Forty cases with a broad range of injuries were classified independently twice by group members 1 month apart and analyzed for classification reliability using the Kappa coefficient (κ).
The morphologic classification is based on 3 main injury patterns: type A (compression), type B (tension band disruption), and type C (displacement/translation) injuries. Reliability in the identification of a morphologic injury type was substantial (κ= 0.72).
The AOSpine TL injury classification system is clinically relevant according to the consensus agreement of our international team of spine trauma experts. Final evaluation data showed reasonable reliability and accuracy, but further clinical validation of the proposed system requires prospective observational data collection documenting use of the classification system, therapeutic decision making, and clinical follow-up evaluation by a large number of surgeons from different countries.
可靠性和一致性研究，回顾性病例系列。
开发一种广泛接受的、全面而简单的分类系统，具有临床可接受的内部和观察者间可靠性，可用于临床实践和研究。
尽管 Magerl 分类和胸腰椎损伤分类系统（TLICS）都是描述胸腰椎（TL）骨折的知名方案，但没有一种 TL 损伤分类系统获得了普遍的国际认可。这种缺乏共识限制了临床医生和研究人员之间的沟通，使这些损伤的研究和治疗方案的制定变得复杂。
使用结构化的国际共识过程开发了一种简单且可重复的 TL 损伤分类系统。该分类系统包括骨折的形态学分类、神经状态的分级系统以及相关患者特定修饰符的描述。将 40 例具有广泛损伤的病例由小组成员在相隔 1 个月的时间内独立进行两次分类，并使用 Kappa 系数（κ）分析分类可靠性。
形态学分类基于 3 种主要的损伤模式：A型（压缩）、B 型（张力带破坏）和 C 型（移位/平移）损伤。形态损伤类型的识别具有较高的可靠性（κ=0.72）。
根据我们国际脊柱创伤专家小组的共识，AOSpine TL 损伤分类系统具有临床相关性。最终评估数据显示了合理的可靠性和准确性，但需要前瞻性观察性数据收集，记录分类系统的使用、治疗决策以及来自不同国家的大量外科医生的临床随访评估，以进一步验证该系统。
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