联合胸腰椎损伤分类与严重度评分和载荷分享评分在胸腰椎骨折手术决策中的应用价值  

Application value of thoracolumbar injury classification and severity score combined with load sharing classification in deciding surgery for thoracolumbar fractures

作　　者：张池明[1] 张剑[1] 胡子昂[1] 赵兴[1] 范顺武[1] Zhang Chiming;Zhang Jian;Hu Ziang;Zhao Xing;Fan Shunwu(Department of Orthopedics,Sir RunRun Shaw Hospital,Medical School of Zhejiang University,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016

出　　处：《中华创伤杂志》2019年第6期494-500,共7页Chinese Journal of Trauma

基　　金：浙江省医药科技卫生计划(2017KY397);浙江省基础公益研究计划(GF18H060011).

摘　　要：目的探讨联合胸腰椎损伤分类与严重度评分(TLICS)和载荷分享评分(LSC)在胸腰椎骨折患者术前手术决策中的应用价值。方法采用回顾性病例系列研究分析2013年1月—2015年11月浙江大学医学院附属邵逸夫医院收治的42例胸腰椎骨折患者临床资料,其中男28例,女14例;年龄19~58岁[(39.5±11.5)岁]。损伤节段:T11 2例,T12 12例,L1 4例;L2 24例。美国脊髓损伤协会(ASIA)分级:A级2例,B级5例,C级6例,D级2例,其余患者神经功能良好。按照TLICS+LSC选择手术方式,A组:TLICS>4分、LSC<7分,行后路内固定治疗,共17例;B组:TLICS≤4分、LSC≥7分,行前路重建内固定治疗,共19例;C组:TLICS>4分、LSC≥7分,行前路重建+后路内固定治疗,共6例。采用ASIA分级标准评估患者神经功能恢复情况;在全长位、侧位X线片或CT矢状位重建像上测量椎体高度和矢状位Cobb角变化;侧位X线片或CT矢状位重建观察人工椎体和螺钉有无松动迹象。采用视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评价疼痛缓解及功能恢复情况。结果患者均获随访18~24个月[(22.2±2.0)个月]。ASIA分级2例A级患者(C组),1例恢复至C级,1例无改善;5例B级患者,3例(B组)恢复至D级,2例(C组)恢复至C级;6例C级患者(A组4例,B组2例)及2例D级患者(A组)均恢复至E级(P<0.05)。后凸Cobb角从术前(26.1±5.6)°恢复至术后即刻(3.7±1.5)°,末次随访时的(4.8±1.0)°(P<0.05)。患者均未出现人工椎体或螺钉松动。VAS由术前(6.3±0.9)分降至末次随访的(2.0±0.7)分,ODI由术前的72.6±9.2降至末次随访的25.2±5.2(P<0.05)。结论对于胸腰椎骨折,TLICS+LSC联用能明确指导手术决策。根据联合评分结果制订手术方案,术后患者局部后凸角明显恢复,疼痛明显减轻,功能得到显著改善。Objective To investigate the application of combination of thoracolumbar injury classification severity score and load sharing classification(TLICS+LSC)in deciding the surgery for thoracolumbar fractures.Methods A retrospective case series study was conducted to analyze the clinical data of 42 patients with thoracolumbar fractures admitted to Sir RunRun Shaw Hospital affiliated to Medical College of Zhejiang University from January 2013 to November 2015.There were 28 males and 14 females,aged 19-58 years[(39.5±11.5)years].The injured segments included T11 in 2 patients,T12 in 12,L1 in 4,L2 in 24.According to American Spinal Injury Association(ASIA)classification,there were two patients with grade A,five patients with grade B,six patients with grade C,and two patients with grade D.The rest of the patients had good neurological function.Surgical methods were selected according to the TLICS+LSC system.Seventeen patients were treated with posterior internal fixation(TLICS>4 points,LSC<7 points)(Group A),19 patients were treated with anterior reconstruction and internal fixation(TLICS≤4 points,LSC≥7 points)(Group B),and six patients were treated with anterior reconstruction and posterior internal fixation(TLICS>4 points,LSC≥7 points)(Group C).ASIA grading criteria were used to assess the neurological function recovery of the patients.Vertebral height and sagittal Cobb angle changes were measured on full-length,lateral X-ray or CT sagittal reconstruction images.Artificial vertebral body and screw loosening were observed on lateral X-ray or CT sagittal reconstruction images.Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)were used to evaluate pain relief and functional recovery.Results All patients were followed up for 18-24 months[(22.2±2.0)months].base on ASIA grading criteria:one grade A(Group C)was restored to grade C,three grade B(Group B)were restored to grade D,two grade B(Group C)were restored to grade C,six grade C(four in Group A,two in Group B)and two grade D(Group A)were restored to grad

关 键 词：脊柱骨折 胸椎 腰椎 方案评估 

分 类 号：R687.3[医药卫生—骨科学]