Reinhold M, Knop C, Beisse R, Audigé L, Kandziora F, Pizanis A, Pranzl R, Gercek E, Schultheiss M, Weckbach A, Bühren V, Blauth M
Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Innsbruck, Osterreich.
Unfallchirurg. 2009 Jan;112(1):33-42, 44-5. doi: 10.1007/s00113-008-1524-7.
The Spine Study Group (AG WS) of the German Trauma Association (DGU) has now been in existence for more than a decade. Its main objective is the evaluation and optimization of the operative treatment for traumatic spinal injuries. The authors present the results of the second prospective internet-based multicenter study (MCS II) of the AG WS in three consecutive parts: epidemiology, surgical treatment and radiologic findings and follow-up results. The aim of the study was to update and review the state-of-the art for treatment of spinal fractures for thoracic and lumbar spine (T1-L5) injuries in German-speaking countries: which lesions will be treated with which procedure and what differences can be found in the course of treatment and the clinical and radiological outcome? This present first part of the study outlines the new study design and concept of an internet-based data collection system. The epidemiologic findings and characteristics of the three major treatment subgroups of the study collective will be presented: operative treatment (OP), non-operative treatment (KONS), and patients receiving a kyphoplasty and/or vertebroplasty without additional instrumentation (PLASTIE). A total of 865 patients (OP n=733, KONS n=52, PLASTIE n=69, other n=7) from 8 German and Austrian trauma centers were included. The main causes of accidents in the OP subgroup were motor vehicle accidents 27.1% and trivial falls 15.8% (KONS 55.8%, PLASTIE 66.7%). The Magerl/AO classification scheme was used and 548 (63.3%) compression fractures (type A), 181 (20.9%) distraction injuries (type B), and 136 (15.7%) rotational injuries (type C) were diagnosed. Of the fractures 68.8% were located at the thoracolumbar junction (T11-L2). Type B and type C injuries carried a higher risk for concomitant injuries, neurological deficits and additional vertebral fractures. The average initial VAS spine score, representing the status before the trauma, varied between treatment subgroups (OP 80, KONS 75, PLASTIE 72) and declined with increasing patient age (p<0.01).
德国创伤协会（DGU）的脊柱研究小组（AG WS）现已成立十余年。其主要目标是评估和优化创伤性脊柱损伤的手术治疗。作者分三个连续部分介绍了AG WS的第二项基于互联网的前瞻性多中心研究（MCS II）的结果：流行病学、手术治疗、放射学检查结果及随访结果。该研究的目的是更新和回顾德语国家胸腰椎（T1-L5）损伤的脊柱骨折治疗的最新技术：哪些损伤将采用何种手术治疗，以及在治疗过程、临床和放射学结果中能发现哪些差异？本研究的第一部分概述了基于互联网的数据收集系统的新研究设计和概念。将介绍研究群体中三个主要治疗亚组的流行病学发现和特征：手术治疗（OP）、非手术治疗（KONS）以及接受椎体后凸成形术和/或椎体成形术且无额外内固定的患者（PLASTIE）。来自8个德国和奥地利创伤中心的865例患者（OP组n = 733，KONS组n = 52，PLASTIE组n = 69，其他组n = 7）被纳入研究。OP亚组的主要事故原因是机动车事故（27.1%）和轻微跌倒（15.8%）（KONS组为55.8%，PLASTIE组为66.7%）。采用Magerl/AO分类法，诊断出548例（63.3%）压缩性骨折（A型）、181例（20.9%）牵张性损伤（B型）和136例（15.7%）旋转性损伤（C型）。68.8%的骨折位于胸腰段交界处（T11-L2）。B型和C型损伤发生合并伤、神经功能缺损和额外椎体骨折的风险更高。代表创伤前状态的平均初始脊柱视觉模拟评分（VAS）在各治疗亚组之间有所不同（OP组80分，KONS组75分，PLASTIE组72分），且随患者年龄增加而下降（p<0.01）。
