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胸腰椎骨折决定脊柱骨折手术TLICS 分型评分科学指导胸腰椎骨折是临床上较为常见的疾病，TLICS 评分是临床推广一个分型方法，该评分方法应用相对方便，计分规则较为客观，这一评分系统对是否手术治疗提供相对明确的指导意见，已经得到广泛的临床应用。
TLICS 分型TLICS（Thoracolumbar injury classification and severity score）评分最早由 Vaccaro 等人 2005 年提出，主要包含三个条目，即骨折形态、神经功能状态、后方韧带复合体（PLC）损伤程度等。
对每个条目依据不同的特点赋予对应的分数，计算总和，超过 4 分推荐手术治疗，小于 4 分推荐保守治疗，等于 4 分，取决手术医生对手术适应症把握。
TLISS 分型关系TLISS 分型是 TLICS 分型的最初版本。
两者差别的主要点在于对骨折评估的方法，TLISS 注重从骨折机制进行评分，而 TLICS 注重从骨折形态进行评分，从评分一致性角度来说，骨折形态是一个更为客观的评估指标，而骨折机制主观性较大，一致性较差，因此目前主要采用对骨折形态评分的方法。
两者容易出现混淆的原因一方面是上述方法的作者均为Vaccaro，两者发表时间过于接近，另一方面是两个评分差别非常细微，仅在骨折评分方面存在细微差异。
TLICS 评分最佳翻译TLISC 评分主要由骨折形态、PLC 完整性、神经功能状态等三部分组成。
椎体爆裂性骨折伴随 PLC 损伤的患者，应该归类为牵张性损伤（4 分）还是单纯的爆裂性骨折（2 分）。
Distraction 翻译成牵张性损伤，更多强调的是骨折损伤机制，而非骨折形态。
在 TLICS 原文里对 Distraction 有非常明确的定义：脊柱头端和尾端结构出现分离，即为 distraction。
从这个定义上来说，distraction 翻译成分离性损伤会更符合 TLICS 评分对骨折形态的定义。
AO-C1型胸腰椎骨折脱位：可选择4钉2棒置入单节段复位固定唐焕章;徐皓;董亮;赵晓明【摘要】BACKGROUND:The type AO-C1 thoracolumbar acute spine injury is a kind of high-energy instable injury, can cause thoracolumbar fracture-dislocation, and mainly associated with spinal nerve injury. Generaly, al needs to posterior open reduction, decompression, bone graft fusion and multiple-segmental internal fixation of pedicle screw rod system, which causes excessive loss of spinal movement segment and a large number of application of internal fixators. OBJECTIVE:To evaluate the treatment effect of posterior pedicle screw mono-segmental internal fixation for treatment of the type AO-C1 thoracolumbar vertebrae fracture-dislocations. METHODS:From January 2008 to December 2013, 17 cases of type AO-C1 thoracolumbar fracture-dislocation were folowed up. Al patients were treated with one-stage posterior open reduction and pedicle screw-rod fixation. Of them, eight cases received four screws and two rods for single-segment fixation in upper and lower vertebrae adjacent to intervertebral space after dislocation (4-screw 2-rod group). Nine cases received eight screws and two rods for multiple-segment fixation in the upper and lower vertebrae adjacent to intervertebral space after dislocation (8-screw 2-rod group). Operative time and intraoperative blood loss were compared between the two groups. The Cobb’s angle was measured on lateral X-ray film of two groups preoperatively and 1 weekpostoperatively and during the final folow-up. The neurological function was evaluated by Frankel classification. The visual analogue scale was adopted to assess the degree of low back pain. RESULTS AND CONCLUSION:Patients were folowed up for 1 to 5 years. Significant differences were detected in the operative time between the two groups, and operative time was better in the 4-screw 2-rod group than in the 8-screw 2-rod group (P < 0.05). No significant difference was found in intraoperative blood loss between the two groups. The deformity of fracture-dislocation had been corrected, and the pain of low back had significantly relieved in al patients after fixation. According to Frankel classification, two cases at Grade A were improved to Grade E, but eight cases at Grade A got no improvement after treatment. Two cases at Grade B were also improved to Grade E at the final folow-up. Significant differences in Cobb’s angle and visual analogue scale were detectable at 1 week postoperatively and during final folow-up as compared with preoperatively (P < 0.05), but no significant difference was visible between final folow-up and 1 week postoperatively. No significant difference in Cobb’s angle and visual analogue scale was observed between the 4-screw 2-rod group and 8-screw 2-rod group. Results indicate that there was no significant difference in the clinical efficacy between 4-screw 2-rod single-segment and 8-screw 2-rod multiple-segment fixation for treating type C1 thoracolumbar vertebrae fracture-dislocation. Therefore, AO-C1 thoracolumbar vertebrae fracture-dislocation could be treated with 4-screw 2-rod single-segment reduction fixation.%背景：AO-C型胸腰椎急性损伤是一种高能量、不稳定性损伤，导致胸腰椎骨折脱位，多伴有脊髓神经损伤，一般均需后路切开复位、减压、植骨融合、椎弓根钉棒系统多节段内固定，致使脊椎运动节段过多丧失、内植物大量应用。
胸腰椎骨折治疗的研究进展(综述)李圣【摘要】胸腰椎骨折是指发生于胸11至腰1之间的脊柱骨折,由于其为胸腰椎移行区,为生物应力的集中点,所以易于发生损伤,而胸腰椎骨折的治疗目标是让患者存活,避免更进一步的神经损害,通过重建脊柱序列获得脊柱的稳定性并通过早期的活动及康复,从而使患者尽快恢复正常工作.胸腰椎骨折因其固有的解剖特点,在诊断、治疗等方面有其特殊性,且因其发生率较高,为临床工作经常遇到的疾病,为了更好的指导临床工作,现就胸腰椎骨折治疗的研究进展做一综述.%The thoracolumbar fracture are the spine fractures occurring at the T11 to the L1 level.Because it's the transition region of thoracolumbar spine and the focus of the biological stress,it is easy to damage.The goal of treatment of the thoracolumbar fracture is keeping patients alive,protecting from the further neural damage,obtaining the stability by constructing anatomical alignment of spinal columns and returning patients to workplace through early mobilization and rehabilitation.Because of its inherent anatomical features,the diagnosis and the treatment of thoracolumbar fracture are special,and there is a high morbidity of thoracolumbar fracture,which we are frequently encountering in the clinical work.To guide the clinical work better,we will take a review about the research progress of the treatment of thoracolumbar fracture.【期刊名称】《安徽卫生职业技术学院学报》【年(卷),期】2015(014)006【总页数】3页(P38-40)【关键词】胸腰椎;脊柱骨折;治疗;综述【作者】李圣【作者单位】舒城县人民医院骨一科安徽 231300【正文语种】中文【中图分类】R687.3脊柱骨折90%发生在胸腰段过渡区[1]，胸腰段正好介于活动度较小的胸椎和活动度较大的腰椎之间，承受的生物学应力较大，故而成为脊柱骨折的好发部位，尽管胸腰椎骨折很常见，但是其中有50%是不稳定的，并可以导致严重的功能丧失、畸形和神经损伤[2]，因而选择合适的治疗方法是非常重要的。
胸腰椎骨折分类的研究进展蒋荣辉【摘要】Due to the various existing external factors, the thoracic and lumbar spine fractures occur more frequently in recent years. The treatment and classification of thoracolumbar fractures are closely related. Scientific, rational and sound classification can guide the clinicians to select the most appropriate treatment, which is the basis and premise of good therapeutic effect, however, the traditional thoracolumbar fracture's classification has certain shortcomings, which reduces the therapeutic effect to a great extent. Thoracolumbar injury severity scoring system and thoracolumbar injury classification and severity scoring system combines fracture and neurological status to give a comprehensive assessment, which is featured with comprehensiveness, high credibility and repeatability, and is the most reliable classification scoring system so far.%由于各种外界因素的影响,近年来胸腰椎骨折的发病率较高.其治疗与分类是密不可分的,科学、合理和完善的分类能正确地指导临床医师选择最适宜的治疗方法,是获得良好治疗效果的基础和前提.然而,传统的胸腰椎骨折分类存在着一定的不足之处,在很大程度上影响了胸腰椎骨折的治疗效果.胸腰椎损伤严重度评分系统和胸腰椎损伤分类及严重度评分系统将骨折与神经功能状态相结合,对胸腰椎骨折进行综合评价,具有全面性及较高的可信度和可重复性,是目前最为可靠的分类评分系统.【期刊名称】《医学综述》【年(卷),期】2013(019)008【总页数】4页(P1432-1435)【关键词】胸腰椎骨折;分类;胸腰椎损伤严重度评分系统【作者】蒋荣辉【作者单位】同济大学医学院、同济大学附属同济医院脊柱外科,上海,200000;余姚市人民医院外科,浙江,余姚,315400【正文语种】中文【中图分类】R683.2随着胸腰椎损伤机制的日益复杂化，传统的胸腰椎骨折的分类已不能满足临床发展的需要。
