胸腰椎损伤分类与严重程度评分（TLICS）指导治疗决策的一致性与变异性。
完整摘要 · 中文译文
研究设计：系统评价和汇总分析。 目的：评估胸腰椎损伤分型和严重程度评分（TLICS）建议与胸腰椎创伤实际治疗决策之间的一致性。 背景资料摘要：TLICS被广泛用于指导胸腰椎骨折的治疗，建议评分≤3分者采取非手术治疗，评分≥5分者采取手术干预。然而，在评分不确定、后纵韧带复合体（PLC）完整性不明确或存在评分框架未能充分涵盖的临床修正因素时，治疗可能存在差异。 方法：对PubMed和Embase数据库进行系统检索。纳入报告TLICS评分及相应治疗决策的研究。计算以下情况的汇总比例：TLICS≤3分接受手术治疗、TLICS≥5分接受非手术治疗、TLICS=4分接受手术治疗，以及初始非手术治疗后延迟手术。采用I²统计量评估异质性。 结果：共纳入14项研究，包含1,221例患者。在TLICS≤3分的患者中，13.7%（95% CI：8.7–20.9）接受了手术治疗。在TLICS≥5分的患者中，6.1%（95% CI：3.2–11.3）接受了非手术治疗。TLICS=4分的患者中，接受手术治疗的比例为49.6%（95% CI：37.6–61.6）。初始非手术治疗后延迟手术的发生率为7.5%（95% CI：2.9–18.2）。各研究间存在显著异质性。 结论：在大多数低评分和高评分患者中，基于TLICS的建议与治疗决策一致。 胸腰椎骨折。观察到的治疗差异似乎出现在可预测的情境中，包括后纵韧带复合体（PLC）评估的不确定性、边缘性损伤形态以及患者特异性的临床修正因素。这些发现支持继续将 TLICS 作为与临床判断相结合的决策支持框架使用，同时也指出了未来胸腰椎创伤流程的改进可借鉴不断演变的临床实践。
完整摘要 · 英文原文
STUDY DESIGN: Systematic review and pooled analysis. OBJECTIVE: To evaluate the concordance between Thoracolumbar Injury Classification and Severity Score (TLICS) recommendations and actual treatment decisions in thoracolumbar trauma. SUMMARY OF BACKGROUND DATA: TLICS is widely used to guide management of thoracolumbar fractures, recommending nonoperative treatment for scores ≤3 and operative intervention for scores ≥5. However, treatment variability may occur in cases with indeterminate scores, uncertainty in posterior ligamentous complex (PLC) integrity, or clinical modifiers not fully captured within the scoring framework. METHODS: A systematic review of PubMed and Embase databases was performed. Studies reporting TLICS scores and corresponding treatment decisions were included. Pooled proportions were calculated for operative treatment in TLICS ≤3, nonoperative treatment in TLICS ≥5, operative treatment in TLICS =4, and delayed surgery following initial nonoperative management. Heterogeneity was assessed using I² statistic. RESULTS: Fourteen studies encompassing 1,221 patients were included. Among patients with TLICS ≤3, 13.7% (95% CI: 8.7-20.9) underwent operative treatment. In TLICS ≥5 patients, 6.1% (95% CI: 3.2-11.3) were treated nonoperatively. Operative treatment in TLICS=4 occurred in 49.6% (95% CI: 37.6-61.6). Delayed surgery after initial nonoperative management occurred in 7.5% (95% CI: 2.9-18.2). Significant heterogeneity was observed across studies. CONCLUSION: TLICS-based recommendations were concordant with treatment decisions in most low- and high-score thoracolumbar fractures. Observed treatment variability appeared to arise in predictable settings, including uncertainty in PLC assessment, borderline injury morphology, and patient-specific clinical modifiers. These findings support continued use of TLICS as a decision-support framework integrated with clinical judgment while identifying areas where future refinement of thoracolumbar trauma algorithms may be informed by evolving clinical practice.