Hitchon Patrick W, He Wenzhuan, Viljoen Stephen, Dahdaleh Nader S, Kumar Rajinder, Noeller Jennifer, Torner James
Department of Neurosurgery, University of Iowa , Iowa City, IA , USA.
Br J Neurosurg. 2014 Oct;28(5):653-7. doi: 10.3109/02688697.2013.872226. Epub 2013 Dec 30.
Burst fractures without neurological deficit are often treated successfully without surgery. A subgroup may fail non-operative treatment owing to pain, and opt for surgery. The following review was conducted to identify predictors of success or failure in the non-operative treatment of thoracolumbar burst fractures.
A cohort of 60 patients with T11-L4 thoracolumbar burst fractures were treated non-operatively, with bed rest and bracing until the pain abated sufficiently to allow mobilization. Patients were followed prospectively for a mean ± SD of 12 ± 14 months, and their data were reviewed retrospectively.
Fifty-one patients successfully completed non-operative treatment. Owing to intractable pain in nine, surgery was undertaken. Ages in the non-operative and operative groups were 46 ± 18 and 68 ± 15 years respectively (p = 0.002). The residual canal and angulation at the site of the fracture were 63 ± 12% and 1.6 ± 8.4° in the non-operative group and 47 ± 15% and 6.6 ± 13.6° in the surgical group (p = 0.001 and 0.149 between groups, respectively). Regression analysis of age, gender, angulation, and residual canal showed that only age (OR, 1.099; 95% CI, 1.022-1.183; p = 0.011) and residual canal (OR, 0.795; 95% CI, 0.642-0.985; p = 0.035) were significant predictors of failure, ultimately undergoing surgery.
Non-surgical treatment was more likely to prove sufficient in patients aged 46 ± 18 years, and residual canal of 63 ± 12%, than in older patients with ages of 68 ± 15, and canal of 47 ± 15%. The latter group was more likely to fail, undergoing surgery because of pain or instability.
无神经功能缺损的爆裂骨折通常无需手术即可成功治疗。但有一小部分患者可能因疼痛而非手术治疗失败，从而选择手术。进行以下综述以确定胸腰椎爆裂骨折非手术治疗成功或失败的预测因素。
对60例T11-L4胸腰椎爆裂骨折患者进行非手术治疗，卧床休息并佩戴支具，直至疼痛减轻到足以允许活动。对患者进行前瞻性随访，平均随访时间为12±14个月，并对其数据进行回顾性分析。
51例患者成功完成非手术治疗。9例因顽固性疼痛而接受手术。非手术组和手术组的年龄分别为46±18岁和68±15岁（p = 0.002）。非手术组骨折部位的残余椎管和角度分别为63±12%和1.6±8.4°，手术组为47±15%和6.6±13.6°（两组之间p分别为0.001和0.149）。对年龄、性别、角度和残余椎管进行回归分析，结果显示只有年龄（OR，1.099；95%CI，1.022-1.183；p = 0.011）和残余椎管（OR，0.795；95%CI，0.642-0.985；p = 0.035）是失败的显著预测因素，最终接受了手术。
与年龄为68±15岁、椎管为47±15%的老年患者相比，年龄为46±18岁、残余椎管为63±12%的患者非手术治疗更有可能足够。后一组更有可能治疗失败，因疼痛或不稳定而接受手术。
