Department of Orthopaedics and Rehabilitation, University of Rochester, Rochester, NY 14642, USA.
Spine (Phila Pa 1976). 2013 Mar 1;38(5):E270-5. doi: 10.1097/BRS.0b013e3182804c73.
A gross anatomic and motion analysis study in cadavers.
Assess spinal motion in a cadaveric spinal fracture model and investigate the ability of external orthoses to control this motion.
External orthoses are frequently prescribed for patients who have experienced burst fracture of the thoracolumbar spine. Despite the substantial expense involved, there is little data confirming their value.
A T12 burst fracture model was created in 5 lightly embalmed cadavers by resecting the anterior and middle columns of the T12 vertebra through a thoracolumbar anterior approach to the spine. An electromagnetic motion tracking and analysis system was used to track angular and linear displacement at the fracture during routine patient maneuvers. Several commonly used orthoses, including an extension brace and both an "off-the-shelf" and custom-molded thoracic-lumbar-sacral orthosis (TLSO), were applied to the cadavers and the affect on fracture site motion was assessed.
Application of all 3 styles of brace resulted in angular motion of 8° to 12° in flexion-extension, 11° to 20° in axial rotation, and 8° to 10° of lateral bending. Brace application resulted in linear displacement of 29 to 46 mm in the medial-lateral plane, 21 to 23 mm in the axial plane, and 21 to 37 mm in the anterior-posterior plane. During logrolling maneuvers, TLSO style braces diminished angular motion, although residual motion in the range of 5° remained. TLSO style braces had little effect on linear translation. When placed in a seated position in bed, TLSO style braces diminished flexion and extension modestly, but did not influence lateral bending or linear translation. Extension style braces had no effect on fracture motion during any activity tested.
In a cadaver model of a burst fracture, there is surprising angular and linear motion at the fracture during common hospital activities. TLSO orthoses can decrease angular motion but do not effect translation at the fracture. An extension orthosis had no effect on motion at the spinal fracture site.
尸体大体解剖和运动分析研究。
评估脊柱骨折模型中脊柱的运动，并研究外部矫形器控制这种运动的能力。
外部矫形器常用于治疗胸腰椎爆裂性骨折的患者。尽管费用高昂，但几乎没有数据证实其价值。
通过经胸腰椎前路到脊柱切除 T12 椎体的前柱和中柱，在 5 具轻度防腐的尸体中创建 T12 爆裂性骨折模型。使用电磁运动跟踪和分析系统跟踪常规患者操作过程中骨折处的角度和线性位移。将几种常用的矫形器（包括伸展支具和“现成的”和定制模制的胸腰椎骶部矫形器（TLSO））应用于尸体，并评估其对骨折部位运动的影响。
所有 3 种支具的应用均导致屈伸时的角度运动为 8°至 12°，轴向旋转时为 11°至 20°，侧屈时为 8°至 10°。支具应用导致在矢状面的线性位移为 29 至 46mm，在轴向平面为 21 至 23mm，在前后平面为 21 至 37mm。在翻身运动中，TLSO 式支具减少了角度运动，但仍存在 5°的残余运动。TLSO 式支具对线性平移几乎没有影响。当患者在床上坐立时，TLSO 式支具适度减少屈伸，但不影响侧屈或线性平移。伸展式支具在测试的任何活动中均对骨折运动无影响。
在爆裂性骨折的尸体模型中，在常见的医院活动中，骨折处存在惊人的角度和线性运动。TLSO 矫形器可以减少角度运动，但不会影响骨折处的平移。伸展式支具对脊柱骨折部位的运动没有影响。
