Panteliadis Pavlos, Musbahi Omar, Muthian Senthil, Goyal Shivam, Montgomery Alexander Sheriff, Ranganathan Arun
Department of Trauma and Orthopedics, Guy's Hospital, Guy's and St Thomas NHS Trust, London, England.
Oxford University Clinical Academic Graduate School, Oxford University, Oxford, England.
Int J Spine Surg. 2017 Dec 5;11(5):32. doi: 10.14444/4032. eCollection 2017.
Management of thoracolumbar fractures remains controversial in the literature. The primary aims of this study were to assess different levels of fixation with respect to radiological outcomes in terms of fracture reduction and future loss of correction.
This is a single center, retrospective study. Fifty-five patients presenting with thoracolumbar fractures between January 2012 and December 2015 were analyzed in the study. The levels of fixation were divided in 3 groups, 1 vertebra above and 1 below the fracture (1/1), 2 above and 2 below (2/2), and 2 above and 1 below (2/1).
The most common mechanism was high fall injury and the most common vertebra L1. Burst fractures were the ones with the highest incidence. The 2/2 fixation achieved the best reduction of the fracture but with no statistical significance. The correction is maintained better by the 2/2 fixation but there is no statistical difference compared to the other fixations. Insertion of screws at the fracture level did not improve outcomes.
The data of this study identified a trend towards better radiological outcomes for fracture reduction and maintenance of the correction in the 2/2 fixations. However these results are not statistically significant. Future multicenter prospective clinical trials are needed in order to agree on the ideal management and method of fixation for thoracolumbar fractures.
胸腰椎骨折的治疗在文献中仍存在争议。本研究的主要目的是评估不同固定水平在骨折复位和未来矫正丢失方面的放射学结果。
这是一项单中心回顾性研究。对2012年1月至2015年12月期间出现胸腰椎骨折的55例患者进行了分析。固定水平分为3组，骨折上方1个椎体和下方1个椎体（1/1），上方2个椎体和下方2个椎体（2/2），以及上方2个椎体和下方1个椎体（2/1）。
最常见的机制是高处坠落伤，最常见的椎体是L1。爆裂骨折的发生率最高。2/2固定实现了最佳的骨折复位，但无统计学意义。2/2固定能更好地维持矫正，但与其他固定方式相比无统计学差异。在骨折水平置入螺钉并未改善结果。
本研究数据显示2/2固定在骨折复位和维持矫正方面有获得更好放射学结果的趋势。然而这些结果无统计学意义。未来需要进行多中心前瞻性临床试验，以便就胸腰椎骨折的理想治疗和固定方法达成共识。
