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胸腰椎创伤后后凸畸形的治疗:保守治疗与手术治疗对比

Management of Post Traumatic Kyphotic Deformity in Thoracolumbar Spine: Conservative versus Operative Treatment.

作者信息

Rahman M M, Islam N A, Islam M S, Rahman M M, Alam M T, Islam M A, Sarker Z H, Islam S

机构信息

Dr Md Matiur Rahman, Junior Consultant (Ortho-surgery), Department of Orthopedics, Mymensingh Medical College and Hospital (MMCH), Mymensingh, Bangladesh.

出版信息

Mymensingh Med J. 2018 Oct;27(4):715-722.

Abstract

Local post traumatic kyphosis may impair spinal sagittal balance and result in seven disability and programmed neurological deficit. In operative group the mean±SD fracture kyphosis was 34.21±3.7 at the time of admission and mean±SD kyphosis was 17.64±3.20 at the time of final follow up. In conservative group the mean±SD kyphosis was 32.96±4.06 at the time of admission and mean±SD kyphosis was 40.28±4.72 at the time of final follow up. It is interesting to note that in conservative group kyphosis increased (7.3) during final follow up but decreased (16.57) in operative group during final follow up due to spinal instrumentation and post-lateral fusion. Local post traumatic kyphosis may impair spinal sagittal balance and result in severe disability and progressive neurological deficit. Objective of the study is to find out the better option in the management of post traumatic kyphotic deformity in thoracolumbar Spain injury. The quasi-experimental study was carried out at the National Institute of Traumatology & Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh from January 2006 to December 2008. A total number of 40 patients with post traumatic thoracolumbar spine injuries with kyphotic deformity selected purposively. Out of 40 cases 1 patient missed from final follow up. Rest of 39 patients was included in this study. All patients were admitted within 3 weeks of injury. Most were referred from peripheral hospital & some were admitted in emergency and outpatient department of NITOR. Among those 25 patients were conservatively treated and 14 were operatively treated. In operative group the mean±SD fracture kyphosis was 34.21±3.7 at the time of admission and mean±SD kyphosis was 17.64±3.20 at the time of final follow up. In conservative group the mean±SD kyphosis was 32.96±4.06 at the time of admission and mean±SD kyphosis was 40.28±4.72 at the time of final follow up. It is to note that in conservative group kyphosis increased (7.3) during final follow up but decreased (16.57) in operative group during final follow up due to spinal instrumentation and post-lateral fusion.

摘要

局部创伤后驼背可能会损害脊柱矢状面平衡,并导致严重残疾和渐进性神经功能缺损。手术组入院时骨折后凸畸形的平均值±标准差为34.21±3.7,末次随访时后凸畸形的平均值±标准差为17.64±3.20。保守组入院时后凸畸形的平均值±标准差为32.96±4.06,末次随访时后凸畸形的平均值±标准差为40.28±4.72。值得注意的是,保守组在末次随访期间后凸畸形增加了(7.3),而手术组由于脊柱内固定和后外侧融合,在末次随访期间后凸畸形减少了(16.57)。局部创伤后驼背可能会损害脊柱矢状面平衡,并导致严重残疾和渐进性神经功能缺损。本研究的目的是找出胸腰椎脊柱损伤后创伤性后凸畸形治疗的更佳选择。该准实验研究于2006年1月至2008年12月在孟加拉国达卡的国家创伤与矫形康复研究所(NITOR)进行。共选取了40例有创伤性胸腰椎脊柱损伤并伴有后凸畸形的患者,采用目的抽样法。40例患者中,1例患者失访。其余39例患者纳入本研究。所有患者均在受伤后3周内入院。大多数患者来自周边医院转诊,部分患者在NITOR急诊科和门诊部入院。其中25例患者接受保守治疗,14例患者接受手术治疗。手术组入院时骨折后凸畸形的平均值±标准差为34.21±3.7,末次随访时后凸畸形的平均值±标准差为17.64±3.20。保守组入院时后凸畸形的平均值±标准差为32.96±4.06,末次随访时后凸畸形的平均值±标准差为40.28±4.72。需要注意的是,保守组在末次随访期间后凸畸形增加了(7.3),而手术组由于脊柱内固定和后外侧融合,在末次随访期间后凸畸形减少了(16.57)。

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