Lucasti Christopher, Scott Maxwell M, Slowinski Joshua, Maraschiello Mark, Clark Lindsey D, Kowalski Joseph M
From the UBMD Orthopaedics and Sports Medicine Doctors Buffalo, Buffalo, NY (Lucasti, Clark, and Kowalski) and the Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY (Scott, Slowinski, and Maraschiello).
J Am Acad Orthop Surg. 2023 May 1;31(9):e481-e488. doi: 10.5435/JAAOS-D-22-00694. Epub 2023 Jan 18.
Thoracolumbar fractures (TLFs) are the most common spinal fractures seen in patients with trauma. The Thoracolumbar Injury Classification and Severity (TLICS) classification system is commonly used to help clinicians make more consistent and objective decisions in assessing the indications for surgical intervention in patients with thoracolumbar fractures. Patients with TLICS scores <4 are treated conservatively, but a percentage of them will have failed conservative treatment and require surgery at a later date.
All patients who received an orthopaedic consult between January 2016 and December 2020 were screened for inclusion and exclusion criteria. For patients meeting the study requirements, deidentified data were collected including demographics, diagnostics workup, and hospital course. Data analysis was conducted comparing length of stay, time between first consult and surgery, and time between surgery and discharge among each group.
1.4% of patients with a TLICS score <4 not treated surgically at initial hospital stay required surgery at a later date. Patients with a TLICS score <4 treated conservatively had a statistically significant shorter hospital stay compared with those treated surgically. However, when time between initial consult and surgery was factored into the total duration of hospital stay for those treated surgically, the duration was statistically equivalent to those treated nonsurgically.
For patients with a TLICS score <4 with delayed mobilization after 3 days in the hospital or polytraumatic injuries, surgical stabilization at initial presentation can decrease the percentage of patients who fail conservative care and require delayed surgery. Patients treated surgically have a longer length of stay than those treated conservatively, but there is no difference in stay when time between consult and surgery was accounted for. In addition, initial surgery in patients with delayed mobilization can prevent long waits to surgery, while conservative measures are exhausted.
Retrospective cohort study.
胸腰椎骨折（TLFs）是创伤患者中最常见的脊柱骨折。胸腰椎损伤分类与严重程度（TLICS）分类系统常用于帮助临床医生在评估胸腰椎骨折患者的手术干预指征时做出更一致、客观的决策。TLICS评分<4分的患者采用保守治疗，但其中一部分患者保守治疗会失败，后期需要手术。
对2016年1月至2020年12月期间接受骨科会诊的所有患者进行纳入和排除标准筛查。对于符合研究要求的患者，收集去识别化的数据，包括人口统计学、诊断检查和住院过程。进行数据分析，比较每组患者的住院时间、首次会诊与手术之间的时间以及手术与出院之间的时间。
初次住院时未接受手术治疗的TLICS评分<4分的患者中有1.4%后期需要手术。与接受手术治疗的患者相比，保守治疗的TLICS评分<4分的患者住院时间在统计学上显著更短。然而，将手术治疗患者的首次会诊与手术之间的时间计入总住院时间后，其住院时间在统计学上与非手术治疗患者相当。
对于住院3天后活动延迟或多发伤的TLICS评分<4分的患者，初次就诊时进行手术稳定可降低保守治疗失败并需要延迟手术的患者比例。手术治疗的患者住院时间比保守治疗的患者长，但计入会诊与手术之间的时间后住院时间无差异。此外，活动延迟患者的初次手术可避免在保守措施用尽时等待手术的漫长时间。
III级证据：回顾性队列研究。
