胸腰椎骨折伤椎承载能力评分系统的建立及临床应用  

Establishment and clinical application of thoracolumbar fracture bearing capacity scoring system

作　　者：孙乐乐 石磊 曹杰 王康康 梁成民[1] SUN Lele;SHI Lei;CAO Jie;WANG Kangkang;LIANG Chengmin(Department of Orthopaedics,Fuyang Hospital of Bengbu Medical College(fuyang people's hospital),Fuyang 236000,Anhui,China)

机构地区：[1]蚌埠医学院附属阜阳医院(阜阳市人民医院)骨科,安徽阜阳236000

出　　处：《中华骨与关节外科杂志》2024年第1期44-49,共6页Chinese Journal of Bone and Joint Surgery

基　　金：蚌埠医学院自然科学重点项目(BYKY2019227ZD);国家骨科与运动康复临床医学研究中心(2021-NCRC-CXJJ-PY-35)。

摘　　要：目的:针对胸腰椎损伤严重程度评分系统(TLICS)评分<4分的胸腰椎骨折提出一种伤椎承载能力评分系统(TFBCSS),并评估其信度及临床疗效。方法:回顾性分析2018年12月至2022年12月收治的TLICS评分<4分的胸腰椎骨折患者,结合患者性别、年龄、体重指数(BMI)、伤椎形态学改变建立TFBCSS,选取5名脊柱外科医师(2名主任医师,3名住院医师)根据影像学特征及患者性别、年龄、BMI对骨折赋分评估,对评分系统进行信度检验,以组内相关系数(ICC)评估该评分系统的可重复性和可靠性。根据TFBCSS总分值(T)不同分为T<4分的保守治疗组和T≥4分的手术治疗组,依据局部后凸角、伤椎前缘椎体高度、疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)随访观察治疗效果。结果:回顾性纳入120例,其中保守治疗组45例,手术治疗组75例,随访时间为12~30个月,平均(18.6±4.6)个月,5名医师对TFBCSS的可重复性ICC分别为保守治疗组平均0.892,手术治疗组平均0.883,可信度ICC分别为保守治疗组平均0.891,手术治疗组平均0.885。两组患者术后的局部后凸角、伤椎前缘椎体高度、VAS评分、ODI末次随访时均较术前显著改善(P均<0.001)。结论:TFBCSS可以用于指导TLICS评分<4分的胸腰椎骨折患者的临床治疗,且具有较强的可重复性和一致性。Objective:This study proposed a thoracolumbar fracture bearing capacity scoring system(TFBCSS)for thoracolumbar fracture with thoracolumbar injury classification and severity(TLICS)score of<4 and evaluated its reliability and clinical efficacy.Methods:A retrospective analysis was conducted on patients with TLICS score<4 who were treated for thoracolumbar fracture from December 2018 to December 2022.The TFBCSS was established based on gender,age,body mass index(BMI),and morphological changes in injured vertebrae.Five spinal surgeons(two chief physicians and three resident physicians)assigned scores to fractures based on imaging features,gender,age,and BMI.The reliability of the scoring system was evaluated.The repeatability and reliability of the TFBCSS were assessed by intra-class correlation coefficient(ICC).Patients were divided into a conservative treatment group(T<4)and a surgical treatment group(T≥4)according to the total TFBCSS value(T).Treatment outcomes were observed based on local kyphosis angle(LAK),anterior vertebral height(AVH),visual analog scale(VAS),and oswestry disability index(ODI).Results:A total of 120 patients were retrospectively included,with 45 patients in the conservative treatment group and 75 patients in the surgical treatment group.The follow-up period ranged from 12 to 30 months,with a mean of(18.6±4.6)months.The mean ICC for the reproducibility of the TFBCSS by the 5 doctors was 0.892 in the conservative treatment group and 0.883 in the surgical treatment group,while the mean ICC for reliability was 0.891 in the conservative treatment group and 0.885 in the surgical treatment group.Both groups showed significant improvement in postoperative LKA,AVH,VAS,and ODI at the last follow-up compared to preoperative values(all P<0.001).Conclusions:The TFBCSS can guide the clinical treatment of thoracolumbar fracture with TLICS score<4 and has strong repeatability and consistency.

关 键 词：胸腰椎骨折 胸腰椎损伤严重程度评分系统 

分 类 号：R683.2[医药卫生—骨科学]