흉요추부 손상에서 TLICS 분류법과 McAfee 분류법의 비교 = Comparison of TLICS & McAfee Classification in Thoracolumbar Injuries

다국어 초록 (Multilingual Abstract)

Study Design: A retrospective study.
Objectives: We assessed the intraobserver and interobserver reliability of TLICS classification in the thoracolumbar injuries, which had been evaluated in our hospital. It was compared with that of the older, McAfee classification and discussed for clinical validation.
Summary of Literature Review: Among the numerous literatures regarding the thoracolumbar injury, there is no consensus on the most useful classification, and there is nothing comparing the McAfee classification with the TLICS classification.
Materials and Methods: Among the 230 patients that were treated with conservative care or operation from January 1, 2005 to January 1, 2010 in our hospital, 185 patients with initial CT and MRI images were assessed. Five orthopedic surgeons reviewed histories, plain film, CT and MRI of the 185 thoracolumbar injury cases, respectively. Each case was classified and scored according to the McAfee classification and the TLICS classification. The case assessment was recorded and the orthopedic surgeons repeated the assessment 1 month later. Intraobserver and interobserver reliability were assessed by statistical analysis. The actual management of each case was compared with the treatment recommended by TLICS classification to calculate the validity of the indexes.
Results: Intraobserver and interobserver reliability in TLICS were higher than those in the McAfee classification. Agreement of the TLICS classification for treatment recommendation was 81.7%, comparing with the actual management of previous McAfee classification. Validity indexes were satisfactory in therapeutic decision making, especially specificity.
Conclusions: TLICS classification has a relative high K-value, when compared with that of the McAfee classification for intraobserver and interobserver reliability. Through clinical studies, including prospective observational analysis, TLICS classification can be applied and adjusted more adequately.

국문 초록 (Abstract)

연구 계획: 후향적 연구목적: 본원에서 치험한 흉요추부 손상에서 TLICS 분류법과 McAfee 분류법을 적용하여 관찰자내 및 관찰자간의 신뢰도를 평가하여 비교하였고, TLICS 분류법의 임상적 적응에 대해 논의 하고자 한다.
선행문헌의 요약: 흉요추부 손상에 관한 많은 문헌이 있으나, 가장 유용한 분류법에 대한 동의는 아직 없으며 또한 McAfee 분류법과 TLICS 분류법과의비교는 없었다.
대상 및 방법: 2005년 1월부터 2010년 1월까지, 흉요추부 골절로 보존적 또는 수술적 치료를 받은 총 230례 중 골절 당시의 단순 방사선 촬영, 컴퓨터단층 촬영, 자기 공명 영상 촬영이 이루어진 총 185례를 대상으로 하였다. 방사선학적인 자료와 임상적인 자료를 토대로 총 5명의 정형외과 의사에 의해 개별적으로 재평가가 이루어졌고 McAfee 분류법과 TLICS 분류법을 사용하여 분석되었다. 1차 평가가 끝난 1개월 후 2차 평가가 이루어졌으며 두차례의 평가를 토대로 통계학적 분석을 시행하여 관찰자내 및 관찰자간의 신뢰도를 확인하였다. 또한 이전 사례들의 실제 치료를 TLICS 분류법으로 재평가하여 치료지침으로의 유효성에 대해 분석하였다.
결과: TLICS 분류법의 관찰자내 및 관찰자간 신뢰도는 McAfee 분류법에 비해 전반적으로 높은 결과를 보였고 이는 통계학적으로 유의하였다. 또한 이전의 실제 치료와 비교한 TLICS 분류법의 치료지침은 81.7%의 동의성을 보였고 특이도 등의 유효성의 측면에서도 좋은 결과를 보였다.
결론: TLICS 분류법은 이전의 McAfee 분류법과 비교하여 관찰자내, 관찰자간의 신뢰도가 높다. 임상적이며 전향적인 연구가 이루어 진다면 환자에게더욱 적합한 치료의 결정을 위해 유용하게 쓰일 것으로 사료된다.

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