AO脊柱胸腰椎损伤分类系统：与儿童胸腰椎损伤分类系统及严重程度评分的比较研究
The AOSpine thoracolumbar spine injury classification system: A comparative study with the thoracolumbar injury classification system and severity score in children.
作者信息
Mo Andrew Z, Miller Patricia E, Troy Michael J, Rademacher Emily S, Hedequist Daniel J
机构信息
Department of Orthopaedic Surgery, Boston Children's Hospital, New York.
Department of Orthopaedics, Boston Children's Hospital, Boston, Massachusetts.
出版信息
OTA Int. 2019 May 14;2(4):e036. doi: 10.1097/OI9.0000000000000036. eCollection 2019 Dec.
BACKGROUND
There is no uniform classification in the pediatric population for thoracolumbar (TL) fractures, nor any operative guidelines. This study evaluates the AOSpine TL spine injury classification in the pediatric population and compares it to the thoracolumbar injury classification system (TLICS), which has previously been validated in pediatric spine trauma.
METHODS
Twenty-eight patients with operative TL injuries were identified from 2006 to 2016. Inclusion criteria included available imaging, operative records, age <18, and posterior approach. Each case was classified by AOSpine TL spine injury classification and TLICS. Each classification was compared to documented intraoperative posterior ligamentous complex (PLC) integrity as well as each other.
RESULTS
Utilizing the AOSpine TL spine injury classification, 7 patients had type A injuries, 15 patients had type B injuries, and 6 patients had type C injuries; 21 patients had injuries classified as involving the PLC. Using TLICS, 16 patients had burst fractures, 6 patients had distraction injuries, and 6 patients had translation injuries; 21 patients had injuries classified as involving the PLC. Spearman correlation analysis substantiated convergence of AOSpine TL spine injury classification scores to TLICS scores ( = 0.75; 95% confidence interval, CI = 0.51 to 0.98; < .001). Concordance between PLC integrity by each classification and intraoperative evaluation was 96% (27/28) of cases ( = 0.91; 95% CI = 0.73 to 1.08). Neurologic status was 100% concordant between the AOSpine TL spine injury classification and TLICS.
CONCLUSION
There is high statistical correlation between the AOSpine TL spine injury classification and TLICS, and to intraoperative evaluation of the PLC, suggesting that the AOSpine TL spine injury classification is applicable to the pediatric population.
LEVEL OF EVIDENCE
III.
背景
在儿童群体中，对于胸腰椎（TL）骨折尚无统一的分类方法，也没有任何手术指南。本研究评估了儿童群体中的AO脊柱胸腰椎损伤分类，并将其与胸腰椎损伤分类系统（TLICS）进行比较，后者此前已在儿童脊柱创伤中得到验证。
方法
从2006年至2016年确定了28例接受手术治疗的胸腰椎损伤患者。纳入标准包括可获得的影像学资料、手术记录、年龄<18岁以及后路手术入路。每例病例均按照AO脊柱胸腰椎损伤分类和TLICS进行分类。将每种分类与记录的术中后韧带复合体（PLC）完整性以及彼此进行比较。
结果
采用AO脊柱胸腰椎损伤分类，7例为A型损伤，15例为B型损伤，6例为C型损伤；21例患者的损伤被分类为累及PLC。使用TLICS时，16例为爆裂骨折，6例为牵张性损伤，6例为平移性损伤；21例患者的损伤被分类为累及PLC。Spearman相关性分析证实AO脊柱胸腰椎损伤分类评分与TLICS评分具有一致性（ = 0.75；95%置信区间，CI = 0.51至0.98； < .001）。每种分类的PLC完整性与术中评估之间的一致性为96%（27/28）的病例（ = 0.91；95% CI = 0.73至1.08）。AO脊柱胸腰椎损伤分类与TLICS之间的神经功能状态一致性为100%。
结论
AO脊柱胸腰椎损伤分类与TLICS之间以及与PLC的术中评估之间存在高度统计学相关性，表明AO脊柱胸腰椎损伤分类适用于儿童群体。
证据级别
III级。
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