Audigé Laurent, Cornelius Carl-Peter, Di Ieva Antonio, Prein Joachim
AO Clinical Investigation and Documentation, AO Foundation, Dübendorf, Switzerland ; Research and Development Department, Schulthess Clinic, Zürich, Switzerland.
Department of Oral and Maxillofacial Surgery, Ludwig Maximilians Universität München, Germany.
Craniomaxillofac Trauma Reconstr. 2014 Dec;7(Suppl 1):S006-14. doi: 10.1055/s-0034-1389556.
Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal.
经过验证的创伤分类系统是为患者护理的可靠记录和评估提供依据的唯一手段，这将为未来几年基于证据的程序和医疗保健打开大门。在AO调查与文档部门的支持下，成立了一个分类小组，以开发和评估颅颌面（CMF）骨折的综合分类系统。起草了人类颅骨主要组成部分骨折分类的蓝图，然后在迭代共识会议期间，由经验丰富的CMF外科医生和一名放射科医生组成的多专业小组按照结构化流程进行评估。在每次会议上，外科医生独立对多达150例连续的CMF骨折病例的放射影像进行分类。在随后的评审会议上，对分类结果中的所有差异进行严格评估，以澄清和改进，直至达成共识。最终的CMF分类系统采用分层结构，分为三个复杂度递增的级别。最基本的1级简单地区分颅骨内的四个骨折部位：下颌骨（代码91）、中面部（代码92）、颅底（代码93）和颅顶（代码94）。2级和3级专注于进一步定义骨折部位和骨折形态，几乎实现骨折模式的个体化映射。这篇介绍性文章描述了AO CMF综合分类系统的基本原理，讨论了方法框架，并深入介绍了核心小组评估过程中的经验和互动。该系统在解剖学和级别方面的详细信息将在本期杂志的一系列重点教程中通过病例示例进行展示。
