Wood Kirkham B, Buttermann Glenn R, Phukan Rishabh, Harrod Christopher C, Mehbod Amir, Shannon Brian, Bono Christopher M, Harris Mitchel B
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey OCC #3800 Boston, MA 02114. E-mail address for K.B. Wood:
Midwest Spine Institute, 1950 Curve Crest Boulevard West, Suite 100, Stillwater, MN 55082.
J Bone Joint Surg Am. 2015 Jan 7;97(1):3-9. doi: 10.2106/JBJS.N.00226.
Studies comparing operative with nonoperative treatment of a stable burst fracture of the thoracolumbar junction in neurologically intact patients have not shown a meaningful difference at early follow-up. To our knowledge, longer-term outcome data have not before been presented.
From 1992 to 1998, forty-seven consecutive patients with a stable thoracolumbar burst fracture and no neurological deficit were evaluated and randomized to one of two treatment groups: operative treatment (posterior or anterior arthrodesis) or nonoperative treatment (a body cast or orthosis). We previously reported the results of follow-up at an average of forty-four months. The current study presents the results of long-term follow-up, at an average of eighteen years (range, sixteen to twenty-two years). As in the earlier study, patients at long-term follow-up indicated the degree of pain on a visual analog scale and completed the Roland and Morris disability questionnaire, the Oswestry Disability Index (ODI) questionnaire, and the Short Form-36 (SF-36) health survey. Work and health status were obtained, and patients were evaluated radiographically.
Of the original operatively treated group of twenty-four patients, follow-up data were obtained for nineteen; one patient had died, and four could not be located. Of the original nonoperatively treated group of twenty-three patients, data were obtained for eighteen; two patients had died, and three could not be located. The average kyphosis was not significantly different between the two groups (13° for those who received operative treatment compared with 19° for those treated nonoperatively). Median scores for pain (4 cm for the operative group and 1.5 cm for the nonoperative group; p = 0.003), ODI scores (20 for the operative group and 2 for the nonoperative group; p <0.001) and Roland and Morris scores (7 for the operative group and 1 for the nonoperative group; p = 0.001) were all significantly better in the group treated nonoperatively. Seven of eight SF-36 scores also favored nonoperative treatment.
While early analysis (four years) revealed few significant differences between the two groups, at long-term follow-up (sixteen to twenty-two years), those with a stable burst fracture who were treated nonoperatively reported less pain and better function compared with those who were treated surgically.
在神经功能完整的患者中，比较胸腰段交界处稳定爆裂骨折手术治疗与非手术治疗的研究在早期随访中未显示出显著差异。据我们所知，此前尚未有长期结果数据的报道。
1992年至1998年，对47例连续的胸腰段稳定爆裂骨折且无神经功能缺损的患者进行评估，并随机分为两个治疗组之一：手术治疗（后路或前路融合术）或非手术治疗（石膏背心或矫形器）。我们之前报告了平均44个月的随访结果。本研究呈现了平均18年（范围16至22年）的长期随访结果。与早期研究一样，长期随访的患者用视觉模拟量表表明疼痛程度，并完成罗兰和莫里斯残疾问卷、奥斯维斯特残疾指数（ODI）问卷以及简明健康调查量表（SF - 36）。获取工作和健康状况信息，并对患者进行影像学评估。
在最初接受手术治疗的24例患者组中，获得了19例的随访数据；1例患者死亡，4例无法找到。在最初接受非手术治疗的23例患者组中，获得了18例的数据；2例患者死亡，3例无法找到。两组之间的平均后凸畸形无显著差异（手术治疗组为13°，非手术治疗组为19°）。疼痛的中位数评分（手术组为4 cm，非手术组为1.5 cm；p = 0.003）、ODI评分（手术组为20，非手术组为2；p <0.001）以及罗兰和莫里斯评分（手术组为7，非手术组为1；p = 0.001）在非手术治疗组均显著更好。SF - 36的8项评分中有7项也支持非手术治疗。
虽然早期分析（4年）显示两组之间几乎没有显著差异，但在长期随访（16至22年）中，与手术治疗的患者相比非手术治疗的稳定爆裂骨折患者报告的疼痛更少且功能更好。
