Melchiorre P J
Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey, Medical School, Newark, NJ, USA.
Arch Phys Med Rehabil. 1999 Feb;80(2):221-4. doi: 10.1016/s0003-9993(99)90125-9.
To identify the acute hospital discharge functional status achieved and the amount of physical therapy (PT) and occupational therapy (OT) received by neurologically intact patients with thoracolumbar vertebral fractures managed only by bracing with a custom-molded thoracolumbosacral orthosis (TLSO). These patients would be expected to ambulate independently soon after receiving their TLSOs unless they had concomitant lower extremity injuries, but they may need assistance with lower extremity activities of daily living.
Retrospective study.
Urban, level I trauma center.
Twenty-seven subjects who sustained one or more thoracolumbar fractures, were neurologically intact, and were managed nonoperatively with a custom-molded TLSO.
Median time to TLSO arrival, start of PT, number of PT sessions, time to ambulate independently from admission, and length of stay (LOS).
Median time to TLSO arrival was 2 days, start of PT was 4 days, number of PT sessions was one, time to ambulate independently from admission was 3(1/2) days, and LOS was 5 days. Subjects with lower extremity fractures required significantly (p < .037) more PT sessions to achieve independent ambulation than those without lower extremity fractures. Almost 89% of the subjects ambulated independently with or without an assistive device at discharge. Fifty-nine percent of subjects were discharged home the day they cleared PT for independent ambulation. Only 11% of the subjects received OT.
A majority of neurologically intact patients with thoracolumbar fractures managed conservatively with a TLSO ambulate independently after receiving one or two sessions of PT and can be discharged home on the same day of PT clearance. Patients with lower-extremity fractures need more PT to achieve independent ambulation. The consequences of a minority of these patients being evaluated and seen by OT are not fully known. Future research may be able to document the need for more OT services.
确定仅采用定制塑形胸腰骶矫形器（TLSO）支具治疗的胸腰椎骨折神经功能完好患者出院时所达到的急性医院功能状态，以及接受物理治疗（PT）和作业治疗（OT）的量。除非这些患者伴有下肢损伤，预计他们在佩戴TLSO后不久即可独立行走，但他们可能需要在下肢日常生活活动方面获得帮助。
回顾性研究。
城市一级创伤中心。
27名发生一处或多处胸腰椎骨折、神经功能完好且采用定制塑形TLSO进行非手术治疗的受试者。
TLSO送达的中位时间、PT开始时间、PT疗程数、自入院起独立行走的时间以及住院时间（LOS）。
TLSO送达的中位时间为2天，PT开始时间为4天，PT疗程数为1次，自入院起独立行走的时间为3.5天，住院时间为5天。与无下肢骨折的受试者相比，有下肢骨折的受试者实现独立行走所需的PT疗程显著更多（p < 0.037）。几乎89%的受试者在出院时无论有无辅助装置均可独立行走。59%的受试者在通过PT实现独立行走当天出院回家。只有11%的受试者接受了OT。
大多数采用TLSO保守治疗的胸腰椎骨折神经功能完好患者在接受一两个疗程的PT后即可独立行走，并可在通过PT的当天出院回家。下肢骨折患者需要更多的PT才能实现独立行走。这些患者中少数接受OT评估和治疗的后果尚不完全清楚。未来的研究或许能够证明需要更多的OT服务。
