Weninger Patrick, Schultz Arthur, Hertz Harald
Trauma Hospital Lorenz Boehler, Donaueschingenstrasse 13, 1200 Vienna, Austria.
Arch Orthop Trauma Surg. 2009 Feb;129(2):207-19. doi: 10.1007/s00402-008-0780-x. Epub 2008 Nov 14.
Both fractures of the lumbar spine and at the thoracolumbar junction are quite common. The treatment of these fracture types is discussed controversially. Some authors advocate surgical treatment even in fractures without neurologic compromise while other series report good results after non-operative treatment.
Between January 1997 and April 2004, 324 patients with spinal fractures were admitted to our institution. Hundred and thirty-six patients with compression and burst type fractures treated by closed reduction and casting were available for follow-up. Their medical records, radiographs and computer tomography scans were reviewed and their functional status was assessed.
94 male (69.1%) and 42 female (30.9%) patients with a mean age of 48.6 years (range 17-81) at time of injury were included. The thoracolumbar junction (T11-L1) was affected in 104 patients (76.5%). 23.5% had lumbar fractures. All of the burst type fractures with involvement of the posterior column affection were type A3.3. fractures according to the Magerl classification. Significant correction of radiographic parameters was achieved in the early postreduction period (P < 0.0001). Reduction could not be maintained at the final follow-up but still showed slight improvement compared to the initial presentation. Reduction could be maintained better in the thoracolumbar region than in the lumbar spine. Neurologic function was restored in all patients with unilateral radicular pain but only one patient recovered fully after cauda equina-syndrome. Patients after lumbar spine indicated a higher level of pain when compared to patients with fractures at the thoracolumbar junction.
Closed reduction and casting is a safe and effective method for treatment of compression and burst type fractures at the thoracolumbar junction and can restore neurologic function in patients with unilateral radicular pain. It is of limited value in lumbar fractures and in burst type fractures with posterior column involvement.
腰椎骨折和胸腰段交界处骨折都颇为常见。对于这些骨折类型的治疗存在争议。一些作者主张即使在无神经损伤的骨折中也进行手术治疗，而其他系列报道非手术治疗后效果良好。
1997年1月至2004年4月期间，324例脊柱骨折患者入住我院。136例接受闭合复位和石膏固定治疗的压缩性和爆裂性骨折患者可供随访。对他们的病历、X线片和计算机断层扫描进行了回顾，并评估了他们的功能状态。
纳入94例男性（69.1%）和42例女性（30.9%）患者，受伤时平均年龄48.6岁（范围17 - 81岁）。104例患者（76.5%）胸腰段交界处（T11 - L1）受累。23.5%为腰椎骨折。根据Magerl分类，所有累及后柱的爆裂性骨折均为A3.3型骨折。复位后早期X线参数得到显著矫正（P < 0.0001）。最终随访时复位未能维持，但与初始表现相比仍有轻微改善。胸腰段区域的复位维持情况优于腰椎。所有单侧神经根性疼痛患者的神经功能均得以恢复，但马尾综合征患者中只有1例完全康复。与胸腰段交界处骨折患者相比，腰椎骨折患者疼痛程度更高。
闭合复位和石膏固定是治疗胸腰段交界处压缩性和爆裂性骨折的安全有效方法，可恢复单侧神经根性疼痛患者的神经功能。在腰椎骨折和累及后柱的爆裂性骨折中其价值有限。
