1National Trauma Research Institute, Melbourne.
2Department of Neurosurgery, The Alfred Hospital, Melbourne.
J Neurosurg Spine. 2022 Jul 29;37(6):914-926. doi: 10.3171/2022.5.SPINE211468. Print 2022 Dec 1.
The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.
A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.
A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable "U-type" fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date.
The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.
本研究旨在描述 AO 脊柱骶骨和骨盆分类系统的起源，同时结合历史上的骶骨和骨盆分级系统进行阐述。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 MEDLINE、EMBASE、Google Scholar 和 Cochrane 数据库进行系统检索，以确定所有现有的骶骨和骨盆骨折分类系统。
本综述共纳入 49 篇文章，包括 23 种骨盆分类系统和 17 种骶骨分级方案。AO 脊柱骶骨和骨盆分类系统代表了这些历史系统的进化产物，也是 5 种经典概念的重新发明。首先，该分类系统按照生物力学稳定性的渐进顺序对骨折类型进行分类，同时考虑到患者的神经状态。其次，传统观点认为 Denis 中央区 III 型骨折的神经缺损发生率最高，但这一观点并没有得到支持，因为该亚组通常包括从良性矢状位无移位骨折到不稳定的“U 型”骨折等广泛的损伤类型。第三，采用了原始形式的 1990 年 Isler 腰骶系统，根据其对后骨盆或脊柱骨盆稳定性的影响可能性对损伤进行分类。第四，引入了新的离散骨折亚型，并承认双侧损伤的重要性。最后，这是迄今为止第一个综合的骶骨和骨盆分类。
AO 脊柱骶骨和骨盆分类是一个普遍适用的系统，它将历史骨折形态重新定义并重新排列成一个合理的层次结构。这是第一个同时解决后骨盆复合体生物力学稳定性和脊柱骨盆稳定性，同时考虑神经状态的分类。在将这种新的分类纳入验证评分系统以指导骶骨和骨盆损伤的管理之前，需要进一步进行高质量的对照试验。
