Oner Cumhur, Rajasekaran Shanmuganathan, Chapman Jens R, Fehlings Michael G, Vaccaro Alexander R, Schroeder Gregory D, Sadiqi Said, Harrop James
*Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands; †Department of Orthopaedics, Trauma and Spine Surgery, Ganga Hospital, Coimbatore, India; ‡Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA; §Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; ‖Institute of Medical Science, University of Toronto, Toronto, ON, Canada; ¶McEwen Centre for Regenerative Medicine, UHN, University of Toronto, Toronto, ON, Canada; **Spine Program, University of Toronto, Toronto, ON, Canada; ††McLaughlin Center in Molecular Medicine, University of Toronto, Toronto, ON, Canada; ‡‡Genetics and Development, Krembil Discovery Tower, Toronto Western Hospital, Toronto, ON, Canada; §§Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA; and ‖‖Department of Neurological and Orthopedic Surgery, Division of Spine and Peripheral Nerve Surgery, Delaware Valley SCI Center, Thomas Jefferson University, Philadelphia, PA, USA.
J Orthop Trauma. 2017 Sep;31 Suppl 4:S1-S6. doi: 10.1097/BOT.0000000000000950.
Although less common than other musculoskeletal injuries, spinal trauma may lead to significantly more disability and costs. During the last 2 decades there was substantial improvement in our understanding of the basic patterns of spinal fractures leading to more reliable classification and injury severity assessment systems but also rapid developments in surgical techniques. Despite these advancements, there remain unresolved issues concerning the management of these injuries. At this moment there is persistent controversy within the spinal trauma community, which can be grouped under 6 headings. First of all there is still no unanimity on the role and timing of medical and surgical interventions for patients with associated neurologic injury. The same is also true for type and timing of surgical intervention in multiply injured patients. In some common injury types like odontoid fractures and burst type (A3-A4) fractures in thoracolumbar spine, there is wide variation in practice between operative versus nonoperative management without clear reasons. Also, the role of different surgical approaches and techniques in certain injury types are not clarified yet. Methods of nonoperative management and care of elderly patients with concurrent complex disorders are also areas where there is no consensus. In this overview article the main reasons for these controversies are reviewed and the possible ways for resolutions are discussed.
尽管脊柱创伤不如其他肌肉骨骼损伤常见，但它可能导致更多的残疾和更高的成本。在过去20年里，我们对脊柱骨折基本模式的理解有了显著进步，这带来了更可靠的分类和损伤严重程度评估系统，同时手术技术也迅速发展。尽管有这些进展，但在这些损伤的治疗方面仍存在未解决的问题。目前，脊柱创伤领域存在持续的争议，可归纳为6个方面。首先，对于伴有神经损伤的患者，医疗和手术干预的作用及时机仍未达成一致。对于多发伤患者的手术干预类型和时机也是如此。在一些常见的损伤类型中，如齿状突骨折和胸腰椎爆裂型（A3 - A4）骨折，手术与非手术治疗的实际应用差异很大，且没有明确原因。此外，不同手术入路和技术在某些损伤类型中的作用也尚未明确。老年患者合并复杂疾病时的非手术治疗和护理方法也是存在争议的领域。在这篇综述文章中，将对这些争议的主要原因进行回顾，并讨论可能的解决方法。
