Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA 98104, USA.
Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S138-45. doi: 10.1097/BRS.0b013e3181d830c1.
Systematic Review.
To determine whether early spinal stabilization in thoracolumbar spine trauma decreases morbidity and mortality.
The role of early spinal stabilization through surgical means may have a number of benefits. These include reduced morbidity and mortality because of more rapid mobilization afforded by spinal column stabilization and a reduction in the incidence and severity of sepsis and respiratory failure. There are several potential disadvantages of early surgery. The most strongly debated is the potential that the additional physiologic injury may result in an unintended increase in morbidity and mortality caused by worsening of existing injuries, such as with pulmonary or intracranial trauma. This problem may be compounded by increased hemorrhage and resulting hypotension. Operating in the presence of missed or underestimated associated injuries or under less-than-ideal conditions relative to the complexity of the surgery and resources required is also a potential disadvantage.
A systematic review of the English-language literature was undertaken for articles published between January 1990 and December 2008. Electronic databases and reference lists of key articles were searched to identify published studies examining the timing of thoracolumbar fracture fixation. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation criteria, assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus.
A total of 68 articles were initially screened, and 9 ultimately met the predetermined inclusion criteria. These studies demonstrated that early stabilization of thoracic fractures reduced the mean number of days on a ventilator, the number of days in intensive care unit and in hospital, and reduced respiratory morbidity compared with late stabilization. This effect, other than the length of hospital stay, was not seen with stabilization of lumbar fractures. There is not enough evidence to determine the effect of the timing of stabilization on mortality in thoracolumbar fractures.
Ideally, patients with unstable thoracic fractures should undergo early (<72 hours) stabilization of their injury to reduce morbidity and, possibly, mortality.
系统评价。
确定胸腰椎创伤中早期脊柱稳定是否降低发病率和死亡率。
通过手术方式早期进行脊柱稳定可能具有许多益处。这些益处包括由于脊柱固定提供的更快的活动而减少发病率和死亡率，以及减少脓毒症和呼吸衰竭的发生率和严重程度。早期手术有几个潜在的缺点。最具争议的是，额外的生理损伤可能导致现有的损伤恶化，例如肺部或颅内创伤，从而导致发病率和死亡率意外增加。这个问题可能会因出血量增加和随之而来的低血压而加剧。在存在漏诊或低估的相关损伤的情况下，或者相对于手术的复杂性和所需的资源条件不理想的情况下进行手术，也是一个潜在的缺点。
对 1990 年 1 月至 2008 年 12 月期间发表的英文文献进行了系统评价。电子数据库和关键文章的参考文献列表被搜索，以确定检查胸腰椎骨折固定时间的已发表研究。两名独立的审查员使用推荐评估、制定和评估标准评估文献的强度，评估质量、数量和结果的一致性。分歧通过协商解决。
最初筛选了 68 篇文章，最终有 9 篇符合预定的纳入标准。这些研究表明，与晚期稳定相比，早期稳定胸骨折可减少呼吸机使用天数、重症监护病房和住院天数，并降低呼吸系统发病率。这种影响除了住院时间外，在腰椎骨折的稳定中并未出现。没有足够的证据来确定胸腰椎骨折稳定时间对死亡率的影响。
理想情况下，不稳定的胸骨折患者应在受伤后尽早（<72 小时）进行稳定治疗，以降低发病率，可能降低死亡率。
