Xing Dan, Chen Yang, Ma Jian-Xiong, Song Dong-Hui, Wang Jie, Yang Yang, Feng Rui, Lu Jun, Ma Xin-Long
Department of Orthopaedics Institute, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin, 300211, China.
Eur Spine J. 2013 Oct;22(10):2157-66. doi: 10.1007/s00586-012-2624-1. Epub 2012 Dec 22.
The optimal timing of stabilization in patients with traumatic thoracolumbar fractures remains controversial. There is currently a lack of consensus on the timing of surgical stabilization, which is limited by the reality that a randomized controlled trial to evaluate early versus late stabilization is difficult to perform. Therefore, the objective of this study was to determine the benefits, safety and costs of early stabilization compared with late stabilization using data available in the current literature.
An electronic literature search was performed in Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials for relevant studies evaluating the timing of surgery in patients with thoracolumbar fractures. Two reviewers independently analyzed and selected each study on the basis of the eligibility criteria. The quality of the included studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system (GRADE). Any disagreements were resolved by consensus.
Ten studies involving 2,512 subjects were identified. These studies demonstrated that early stabilization shortened the hospital length of stay, intensive care unit length of stay, ventilator days and reduced morbidity and hospital expenses for patients with thoracic fractures. However, reduced morbidity and hospital expenses were not observed with stabilization of lumbar fractures. Owing to the very low level of evidence, no conclusion could be made regarding the effect of early stabilization on mortality.
We could adhere to the recommendation that patients with traumatic thoracolumbar fractures should undergo early stabilization, which may reduce the hospital length of stay, intensive care unit length of stay, ventilator days, morbidity and hospital expenses, particularly when the thoracic spine is involved. Individual patient characteristics should be concerned carefully. However, the definite conclusion cannot be made due to the heterogeneity of the included studies and low level of evidence. Further prospective studies are required to confirm whether there are benefits to early stabilization compared with late stabilization.
创伤性胸腰椎骨折患者稳定治疗的最佳时机仍存在争议。目前对于手术稳定治疗的时机缺乏共识，这受到难以开展一项评估早期与晚期稳定治疗的随机对照试验这一现实情况的限制。因此，本研究的目的是利用当前文献中的现有数据，确定早期稳定治疗与晚期稳定治疗相比的益处、安全性和成本。
在Medline、Embase、Cochrane系统评价数据库和Cochrane对照试验中心注册库中进行电子文献检索，以查找评估胸腰椎骨折患者手术时机的相关研究。两名评审员根据纳入标准独立分析并选择每项研究。使用推荐分级评估、制定和评价系统（GRADE）评估纳入研究的质量。任何分歧均通过协商解决。
共确定了10项涉及2512名受试者的研究。这些研究表明，早期稳定治疗缩短了胸椎骨折患者的住院时间、重症监护病房住院时间、呼吸机使用天数，并降低了发病率和住院费用。然而，腰椎骨折稳定治疗并未观察到发病率降低和住院费用减少。由于证据水平极低，无法就早期稳定治疗对死亡率的影响得出结论。
我们可以遵循这样的建议，即创伤性胸腰椎骨折患者应接受早期稳定治疗，这可能会缩短住院时间、重症监护病房住院时间、呼吸机使用天数、降低发病率和住院费用，尤其是当胸椎受累时。应仔细考虑个体患者特征。然而，由于纳入研究的异质性和证据水平较低，无法得出明确结论。需要进一步的前瞻性研究来证实早期稳定治疗与晚期稳定治疗相比是否有益。
