A comprehensive classification of thoracic and lumbar injuries.
A comprehensive classification of thoracic and lumbar injuries.
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DOI：
10.1007/bf02221591
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发表时间：
1994-01-01
期刊：
影响因子：
--
通讯作者：
Nazarian, S
中科院分区：
文献类型：
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作者：
Magerl, F;Aebi, M;Nazarian, S
鉴于目前的知识水平和众多的治疗可能性，现有的胸部和腰部损伤分类系统都不能完全令人满意。经过十多年的研究和对 1445 例连续胸腰椎损伤的回顾，提出了胸腰椎损伤的综合分类。分类主要基于病理形态学标准。根据损伤的主要机制、病理形态学的一致性并考虑到愈合潜力的预后因素来建立类别。该分类反映了形态损伤的渐进程度，由此确定了不稳定程度。损伤在不稳定性方面的严重程度通过其在分类系统中的排名来表示。使用简单的网格（AO 骨折分类的 3-3-3 方案）对损伤进行分组。该网格由 A、B、C 三种类型组成。每种类型又分为三个组，每个组又包含三个具有规格的子组。这些类型具有基本的损伤模式，该模式由作用于脊柱的三个最重要的机制决定：压缩、分散和轴向扭矩。 A 型（椎体压缩）侧重于椎体的损伤模式。 B 型损伤（前部和后部元件损伤伴牵引）的特点是前方或后方的横向破坏。 C 型损伤（旋转引起的前部和后部元件损伤）描述了由轴向扭矩引起的损伤模式。后者最常叠加在 A 型或 B 型病变上。形态学标准主要用于进一步细分损伤。严重性从 A 型到 C 型以及类型、组和进一步细分。对1445例患者的主要损伤程度、类型和组别出现频率以及神经功能缺损的发生率进行分析。大多数损伤发生在胸腰椎交界处周围。胸腰椎上下端和T10水平最常受伤。 A型骨折占66.1%，B型骨折占14.5%，C型骨折占19.4%。稳定型A1型骨折占总数的34.7%。一些损伤模式对于胸腰椎的某些部分是典型的，而其他部分则是针对年龄组的。对 1212 例神经功能缺损（从完全截瘫到单根病变）进行了评估。（摘要截断为 400 字）
In view of the current level of knowledge and the numerous treatment possibilities, none of the existing classification systems of thoracic and lumbar injuries is completely satisfactory. As a result of more than a decade of consideration of the subject matter and a review of 1445 consecutive thoracolumbar injuries, a comprehensive classification of thoracic and lumbar injuries is proposed. The classification is primarily based on pathomorphological criteria. Categories are established according to the main mechanism of injury, pathomorphological uniformity, and in consideration of prognostic aspects regarding healing potential. The classification reflects a progressive scale of morphological damage by which the degree of instability is determined. The severity of the injury in terms of instability is expressed by its ranking within the classification system. A simple grid, the 3-3-3 scheme of the AO fracture classification, was used in grouping the injuries. This grid consists of three types: A, B, and C. Every type has three groups, each of which contains three subgroups with specifications. The types have a fundamental injury pattern which is determined by the three most important mechanisms acting on the spine: compression, distraction, and axial torque. Type A (vertebral body compression) focuses on injury patterns of the vertebral body. Type B injuries (anterior and posterior element injuries with distraction) are characterized by transverse disruption either anteriorly or posteriorly. Type C lesions (anterior and posterior element injuries with rotation) describe injury patterns resulting from axial torque. The latter are most often superimposed on either type A or type B lesions. Morphological criteria are predominantly used for further subdivision of the injuries. Severity progresses from type A through type C as well as within the types, groups, and further subdivisions. The 1445 cases were analyzed with regard to the level of the main injury, the frequency of types and groups, and the incidence of neurological deficit. Most injuries occurred around the thoracolumbar junction. The upper and lower end of the thoracolumbar spine and the T10 level were most infrequently injured. Type A fractures were found in 66.1%, type B in 14.5%, and type C in 19.4% of the cases. Stable type A1 fractures accounted for 34.7% of the total. Some injury patterns are typical for certain sections of the thoracolumbar spine and others for age groups. The neurological deficit, ranging from complete paraplegia to a single root lesion, was evaluated in 1212 cases.(ABSTRACT TRUNCATED AT 400 WORDS)