Soultanis Konstantinos C, Mavrogenis Andreas F, Starantzis Konstantinos A, Markopoulos Christos, Stavropoulos Nikolaos A, Mimidis George, Kokkalis Zinon T, Papagelopoulos Panayiotis J
First Department of Orthopaedics, Athens University Medical School, ATTIKON University Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece.
Eur J Orthop Surg Traumatol. 2014 May;24(4):443-51. doi: 10.1007/s00590-013-1341-8. Epub 2013 Oct 25.
To discuss when and how to operate on thoracic and lumbar spine fractures.
We retrospectively studied 77 consecutive patients with thoracic and lumbar spine fractures treated from 2000 to 2011; 28 patients experienced high-energy spinal trauma and 49 low-energy spinal trauma. Mean follow-up was 5 years (1-11 years). Surgical treatment was done in 15 patients with neurological deficits, and in 16 neurologically intact patients with fractures-dislocations, burst fractures and fractures with marked deformity. Non-surgical treatment was done in 46 neurologically intact patients with simple fracture configurations. Clinical and imaging examination and the Oswestry Disability Index (O.D.I.) questionnaire were obtained.
All patients treated surgically maintained spinal alignment; patients with long fusion maintained the best alignment; however, they experienced back stiffness and moderate low back pain. Patients with combined posterior fusion and kyphoplasty experienced earlier recovery and improved sagittal correction. Mean O.D.I. was 22.4 and 14.2% at 3 and 12 months postoperatively. Thirty six (78%) patients treated non-surgically were asymptomatic, 22 (48%) experienced mild residual kyphosis, 10 (22 %) developed marked deformity during their follow-up and were finally operated; mean O.D.I. was 28.6 and 12.1% at 3 and 12 months. No difference in O.D.I. was observed between patients who had surgical and non-surgical treatment.
Progressive neurological deficits and/or mechanical instability of the spine are absolute indications for early surgical treatment. Younger patients with high-energy spinal trauma, unstable fractures and neurological deficits should be treated surgically in order to provide optimum conditions for neurologic recovery, early mobilization and possibly ambulation. Most cases can be adequately operated through a posterior only surgical approach; an anterior or combined approach is usually indicated for burst and thoracic spine fractures. Postoperative complications, more common infection and neurological deterioration may occur. Elderly, neurologically intact patients with low-energy, stable spinal fractures without marked spinal deformity may be successfully treated conservatively. Most of these patients will do well; however, follow-up for progressive posttraumatic deformity is required.
探讨胸腰椎骨折的手术时机及手术方式。
我们回顾性研究了2000年至2011年间连续收治的77例胸腰椎骨折患者；其中28例为高能量脊柱创伤，49例为低能量脊柱创伤。平均随访时间为5年（1 - 11年）。15例有神经功能缺损的患者以及16例神经功能正常但存在骨折脱位、爆裂骨折和明显畸形的患者接受了手术治疗。46例神经功能正常且骨折类型简单的患者接受了非手术治疗。进行了临床及影像学检查，并采用奥斯维斯特残疾指数（O.D.I.）问卷进行评估。
所有接受手术治疗的患者均维持了脊柱的对线；进行长节段融合的患者对线保持最佳；然而，他们出现了背部僵硬和中度下腰痛。接受后路融合联合椎体后凸成形术的患者恢复较早，矢状面矫正改善。术后3个月和12个月时，平均O.D.I.分别为22.4和14.2%。36例（78%）接受非手术治疗的患者无症状，22例（48%）有轻度残留后凸畸形，10例（22%）在随访期间出现明显畸形，最终接受了手术；术后3个月和12个月时，平均O.D.I.分别为28.6和12.1%。接受手术和非手术治疗的患者在O.D.I.方面未观察到差异。
进行性神经功能缺损和/或脊柱机械性不稳定是早期手术治疗的绝对指征。年轻的高能量脊柱创伤、不稳定骨折及有神经功能缺损的患者应接受手术治疗，以便为神经功能恢复、早期活动及可能的行走提供最佳条件。大多数病例可通过单纯后路手术途径充分完成手术；爆裂骨折和胸椎骨折通常需要前路或联合入路。术后可能会发生并发症，更常见的是感染和神经功能恶化。老年、神经功能正常、低能量、稳定的脊柱骨折且无明显脊柱畸形的患者可通过保守治疗成功治愈。这些患者大多数情况良好；然而，需要对创伤后进行性畸形进行随访。
