Knop C, Blauth M, Bühren V, Hax P M, Kinzl L, Mutschler W, Pommer A, Ulrich C, Wagner S, Weckbach A, Wentzensen A, Wörsdörfer O
Unfallchirurgische Klinik, Medizinische Hochschule Hannover.
Unfallchirurg. 1999 Dec;102(12):924-35. doi: 10.1007/s001130050507.
The authors report on a prospective multicenter study with regard to the operative treatment of fractures and dislocations of the thoracolumbar spine. 18 traumatologic centers in Germany and Austria, forming the working group "spine" of the German Society of Trauma Surgery, are participating in this continuing study. Between September 1994 and December 1996 682 patients (64% male) with an average age of 39 1/2 (7-83) years were entered. The entry criteria included all patients with acute and operatively treated (within 3 weeks after trauma) fractures and dislocations of the thoracolumbar spine (Th 10-L 2). Part 1 of this publication outlines the protocol and epidemiologic data. The incidence of fractures and dislocations of the thoracolumbar spine and associated injuries were recorded according to a standardized protocol, as well as the different operative methods and complications, duration of hospital stay, rehabilitation and incapacity. The analysis of the clinical social and radiological course was a second focus. The most frequent mechanism of injury was a fall (50%) or traffic accident (22%). Most of the fractures occurred at the L 1 level (49%). All injuries were classified according to the ASIF (AO) classification. 65% sustained an A-type fracture (compression fracture). Associated injuries were observed in 35% and 6% were polytraumatized. Extremities and thorax were most frequently affected. Younger age and traffic accidents lead more often to C-type fracture (fracture dislocation) and polytrauma. An increased number of multisegmental or multilevel lesions were observed in polytraumatized patients. There were 16% with incomplete paraplegia (Frankel/ASIA B-D) and 5% with complete paraplegia (Frankel/ASIA A). The rate of patients with initial neurologic deficits significantly increased with the severity of spinal injury according to the Magerl classification. Until discharge a neurologic improvement (at least 1 Frankel/ASIA grade) was observed in 32% of the partially paralyzed (Frankel/ASIA B-D) and in 12% of the patients with complete paraplegia (Frankel/ASIA A). A neurologic deterioration occurred in 3 patients (0.4%). As a base for further follow-up and late results the individual starting point was determined by collecting relevant data of the patients' history: 277 (40.6%) patients suffered from simultaneous diseases, one half was spine related. At the time of injury 559 (82.0%) patients were employed; 429 (62.9%) doing manual work. 369 (54.1%) patients stated sportive activities before the injury and 561 (82.3%) designated their "back function" as normal. For the time before injury the patients scored an average of 93.4 points in the Hannover Spine Score (0-100 points concerning complaints and function of the back/spine).
作者报告了一项关于胸腰椎骨折和脱位手术治疗的前瞻性多中心研究。德国和奥地利的18个创伤学中心组成了德国创伤外科学会的“脊柱”工作组，参与了这项持续研究。在1994年9月至1996年12月期间，纳入了682例患者（64%为男性），平均年龄39.5岁（7 - 83岁）。纳入标准包括所有急性且接受手术治疗（创伤后3周内）的胸腰椎（胸10 - 腰2）骨折和脱位患者。本出版物的第一部分概述了方案和流行病学数据。根据标准化方案记录胸腰椎骨折和脱位的发生率及相关损伤，以及不同的手术方法、并发症、住院时间、康复情况和失能情况。对临床、社会和放射学病程的分析是第二个重点。最常见的损伤机制是跌倒（50%）或交通事故（22%）。大多数骨折发生在腰1水平（49%）。所有损伤均根据ASIF（AO）分类进行分类。65%为A型骨折（压缩骨折）。35%观察到有相关损伤，6%为多发伤。四肢和胸部最常受累。较年轻患者和交通事故更常导致C型骨折（骨折脱位）和多发伤。多发伤患者中多节段或多平面损伤的数量增加。有16%的患者为不完全性截瘫（Frankel/ASIA B - D级），5%为完全性截瘫（Frankel/ASIA A级）。根据Magerl分类，初始神经功能缺损患者的比例随脊柱损伤严重程度显著增加。直至出院，32%的部分瘫痪患者（Frankel/ASIA B - D级）和12%的完全性截瘫患者（Frankel/ASIA A级）神经功能有改善（至少提高1个Frankel/ASIA等级）。3例患者（0.4%）出现神经功能恶化。作为进一步随访和远期结果的基础，通过收集患者病史的相关数据确定个体起始点：277例（40.6%）患者患有合并症，其中一半与脊柱相关。受伤时，559例（82.0%）患者有工作；429例（62.9%）从事体力劳动。369例（54.1%）患者称受伤前有体育活动，561例（82.3%）称其“背部功能”正常。受伤前患者在汉诺威脊柱评分中的平均得分为93.4分（关于背部/脊柱的疼痛和功能，满分100分）。
