Chhabra H S, Kaul R, Kanagaraju V
Department of Spine Service, Indian Spinal Injuries Centre, New Delhi, India.
Spinal Cord. 2015 Jan;53(1):42-8. doi: 10.1038/sc.2014.194. Epub 2014 Nov 11.
Online questionnaire survey.
To obtain the opinion of experts on whether the currently available classification systems for thoracolumbar and subaxial cervical spine injuries meet their expectations with regard to the desired objectives of a good classification system and practical implementability.
An online survey was conducted during August-September 2013 using a specially designed questionnaire. Members of Spine Trauma Study Group of International Spinal Cord Society and other spinal injury experts were approached, and responses were analyzed.
Forty-two spine experts responded. Majority (87.50%, n=35) were involved with education and research. For subaxial cervical spine injuries, Allen Ferguson classification was more commonly used (37.50%, n=15) and thought to be practically implementable in day-to-day practice (30.77%). For thoracolumbar injuries, while Thoracolumbar Injury Classification and Severity Score (TLICS) was more commonly used (47.50%, n=19), the response of experts for practical implementability in day-to-day practice was more evenly distributed among TLICS, AO (Association for Osteosynthesis) and Dennis classifications (30.77, 23.08 and 25.64%, respectively). Experts felt that the classification systems did not serve all the desired objectives. The reliability for residents was especially a concern.
We may still be far from an ideal classification system. Many experts continue to prefer or would consider shifting back to traditional and simpler systems. There is a need for developing classification systems that would be better implementable practically in day-to-day clinical practice, better guide treatment, be more reliable, incorporate other modifiers influencing treatment and be more comprehensive in that order of priority.
在线问卷调查。
了解专家对于目前可用的胸腰椎及下颈椎损伤分类系统是否符合他们对一个良好分类系统的预期目标及实际可操作性的看法。
2013年8月至9月期间使用专门设计的问卷进行在线调查。联系了国际脊髓学会脊柱创伤研究组的成员及其他脊柱损伤专家，并对回复进行了分析。
42位脊柱专家做出了回复。大多数（87.50%，n = 35）从事教育和研究工作。对于下颈椎损伤，Allen Ferguson分类法使用更为普遍（37.50%，n = 15），并且被认为在日常实践中具有实际可操作性（30.77%）。对于胸腰椎损伤，虽然胸腰椎损伤分类及严重程度评分（TLICS）使用更为普遍（47.50%，n = 19），但专家们对于其在日常实践中的实际可操作性的反馈在TLICS、AO（骨科学会）和Dennis分类法之间分布更为平均（分别为30.77%、23.08%和25.64%）。专家们认为这些分类系统并未达成所有预期目标。住院医师对其可靠性尤其感到担忧。
我们可能距离理想的分类系统仍有很大差距。许多专家仍然更喜欢或会考虑转回传统且更简单的系统。需要开发在日常临床实践中更具实际可操作性、能更好地指导治疗、更可靠、纳入影响治疗的其他修正因素且更全面的分类系统，按此优先级顺序进行。
