胸腰椎骨折分型的发展过程及临床意义

Development Process and Clinical Significance of Thoracolumbar Fracture Classifications

随着影像学技术的发展进步、医学知识的推陈出新,胸腰椎骨折分型在过去20年里不断改进,其中Load-sharing、AO和TLICS三种分型在目前临床应用较多。然而现有各分型均存在不同程度的缺陷,如Loadsharing分型未纳入神经功能损伤评估、AO分型太过繁琐、TLICS分型对后方韧带复合体损伤判断可重复性低。临床医生在选择分型时需要能从充分理解到熟练应用,全面评估胸腰椎骨折的损伤机制、神经功能改变、后方韧带复合体的完整性、基于影像学分析的形态学改变及基础疾病情况,从而为患者拟定出最佳的治疗方案。

With the developments of radiological technology and medical knowledge, thoracolumbar classification systems have been constantly improved in the last two decades. Among them, the Load-sharing, AO and TLICS are the popular choices. However, none of the existing thoracolumbar fracture classification systems is fully satisfactory, for instance, the absence of neurological injury evaluation in Load-sharing classification, high complexity of AO classification and low repeatability for estimating the injury of posterior ligamentous complex in TLICS classification. The clinician should better understand and be proficient in use of choosing the classifications. For choosing the best therapeutic regimen for the patients, the clinician should estimate thoroughly the injury mechanism, neurological function, integrity of posterior ligamentous complex, the morphological change based on radiography and the related underlying disease of thoracolumbar fracture.