Masoudi Mohammad S, Haghnegahdar Ali, Ghaffarpasand Fariborz, Ilami Ghazal
*Department of Neurosurgery, AJA University of Medical Sciences, Tehran, Iran †Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Clin Spine Surg. 2017 Oct;30(8):E1066-E1073. doi: 10.1097/BSD.0000000000000546.
A randomized clinical trial.
To compare the functional recovery between early kyphoplasty and conservative care in paratroopers with stable thoracolumbar fractures.
Treatment of traumatic stable thoracolumbar fractures in young individuals is still a debate. Conservative management and kyphoplasty are options of therapy. But enough data are not available for supporting each.
We included 70 paratroopers with stable thoracolumbar fractures (A1 and A2 classification according to AOSpine thoracolumbar spine injury classification system) presenting <60 days after trauma and hyperintensity in T2-weighted magnetic resonance imaging. Old fractures and those requiring fixation were excluded. Patients were randomly assigned to 2 study groups to undergo percutaneous balloon kyphoplasty (n=34) or conservative care (n=36) by applying orthosis for 2 months. Patients were followed for 12 months and were evaluated clinically using visual analogue scale (VAS) and Oswestry disability index (ODI).
The baseline characteristics were comparable between 2 study groups. The VAS score and ODI decreased significantly in both study groups after 12 months of treatment. The VAS score was significantly lower in kyphoplasty group after the intervention (P<0.001), 1 month (P<0.001), 3 months (P<0.001), 6 months (P<0.001), and 12 months (P<0.001) after the intervention. In addition, the ODI was significantly lower after the intervention (P<0.001), 1 month (P<0.001), 3 months (P<0.001), 6 months (P<0.001), and 12 months (P<0.001) after the intervention. Kyphoplasty was associated with shorter duration of returning to parachuting (P<0.001) and shorter duration of absence from work (P<0.001).
Early kyphoplasty in stable thoracolumbar fractures after parachute jumping is associated with less pain, better functional recovery, less days of absence from work, and shorter duration of returning to parachuting.
一项随机临床试验。
比较早期椎体后凸成形术与保守治疗在跳伞致胸腰椎稳定骨折伞兵中的功能恢复情况。
年轻个体创伤性胸腰椎稳定骨折的治疗仍存在争议。保守治疗和椎体后凸成形术都是治疗选择。但目前尚无足够数据支持任何一种方法。
我们纳入了70名跳伞致胸腰椎稳定骨折（根据AOSpine胸腰椎损伤分类系统为A1和A2型）且伤后<60天、T2加权磁共振成像呈高信号的伞兵。排除陈旧性骨折和需要固定的骨折。患者被随机分为2个研究组，分别接受经皮球囊椎体后凸成形术（n = 34）或保守治疗（n = 36），保守治疗采用矫形器固定2个月。对患者进行12个月的随访，并使用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）进行临床评估。
两个研究组的基线特征具有可比性。治疗12个月后，两个研究组的VAS评分和ODI均显著降低。椎体后凸成形术组在干预后、干预后1个月（P<0.001）、3个月（P<0.001）、6个月（P<0.001）和12个月（P<0.001）时的VAS评分均显著更低。此外，椎体后凸成形术组在干预后、干预后1个月（P<0.001）、3个月（P<0.001）、6个月（P<0.001）和12个月（P<0.001）时的ODI也显著更低。椎体后凸成形术与缩短恢复跳伞时间（P<0.001）和缩短缺勤时间（P<0.001）相关。
跳伞后胸腰椎稳定骨折早期行椎体后凸成形术与疼痛减轻、功能恢复更好、缺勤天数减少及恢复跳伞时间缩短相关。
