Curfs I, Schotanus M, VAN Hemert W L W, Heijmans M, DE Bie R A, VAN Rhijn L W, Willems P C P H
Zuyderland Medical Centre, Department of Orthopedic Surgery and Traumatology, Heerlen, Netherlands.
Research School CAPHRI.
Int J Spine Surg. 2020 Dec;14(6):956-969. doi: 10.14444/7145. Epub 2020 Dec 29.
A validated classification remains the key to an appropriate treatment algorithm of traumatic thoracolumbar fractures. Considering the development of many classifications, it is remarkable that consensus about treatment is still lacking. We conducted a systematic review to investigate which classification can be used best for treatment decision making in thoracolumbar fractures.
A comprehensive search was conducted using PubMed, Embase, CINAHL, and Cochrane using the following search terms: classification (mesh), spinal fractures (mesh), and corresponding synonyms. All hits were viewed by 2 independent researchers. Papers were included if analyzing the reliability (kappa values) and clinical usefulness (specificity or sensitivity of an algorithm) of currently most used classifications (Magerl/AO, thoracolumbar injury classification and severity score [TLICS] or thoracolumbar injury severity score, and the new AO spine).
Twenty articles are included. The presented kappa values indicate moderate to substantial agreement for all 3 classifications. Regarding the clinical usefulness, > 90% agreement between actual treatment and classification recommendation is reported for most fractures. However, it appears that over 50% of the patients with a stable burst fracture (TLICS 2, AO-A3/A4) in daily practice are operated, so in these cases treatment decision is not primarily based on classification.
AO, TLICS, and new AO spine classifications have acceptable accuracy (kappa > 0.4), but are limited in clinical usefulness since the treatment recommendation is not always implemented in clinical practice. Differences in treatment decision making arise from several causes, such as surgeon and patient preferences and prognostic factors that are not included in classifications yet. The recently validated thoracolumbar AO spine injury score seems promising for use in clinical practice, because of inclusion of patient-specific modifiers. Future research should prove its definite value in treatment decision making.
Without the appropriate treatment, the impact of traumatic thoracolumbar fractures can be devastating. Therefore it is important to achieve consensus in the treatment of thoracolumbar fractures.
有效的分类仍然是制定合适的胸腰椎创伤骨折治疗方案的关键。鉴于多种分类方法的发展，令人瞩目的是在治疗方面仍缺乏共识。我们进行了一项系统综述，以研究哪种分类方法最适合用于胸腰椎骨折的治疗决策。
使用PubMed、Embase、CINAHL和Cochrane进行全面检索，检索词如下：分类（主题词）、脊柱骨折（主题词）及相应同义词。所有检索结果由两名独立研究人员查看。若论文分析了当前最常用分类方法（马格勒/ AO分类法、胸腰椎损伤分类及严重程度评分[TLICS]或胸腰椎损伤严重程度评分，以及新AO脊柱分类法）的可靠性（kappa值）和临床实用性（算法的特异性或敏感性），则纳入该论文。
共纳入20篇文章。所呈现的kappa值表明，这三种分类方法的一致性为中等至高度。关于临床实用性，大多数骨折的实际治疗与分类建议之间的一致性报告超过90%。然而，在日常实践中，超过50%的稳定爆裂骨折患者（TLICS 2，AO - A3/A4）接受了手术，因此在这些病例中，治疗决策并非主要基于分类。
AO分类法、TLICS和新AO脊柱分类法具有可接受的准确性（kappa > 0.4），但临床实用性有限，因为治疗建议在临床实践中并非总是得到执行。治疗决策的差异源于多种原因，如外科医生和患者的偏好以及分类中尚未纳入的预后因素。最近验证的胸腰椎AO脊柱损伤评分由于纳入了患者特异性修正因素，在临床实践中似乎很有应用前景。未来的研究应证明其在治疗决策中的明确价值。
2级。
若无适当治疗，胸腰椎创伤骨折的影响可能是毁灭性的。因此，在胸腰椎骨折的治疗上达成共识很重要。
