Rava Alessandro, Fusini Federico, Cinnella Pasquale, Massè Alessandro, Girardo Massimo
Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Orthopaedic and Trauma Centre, Spine Surgery Unit, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
J Craniovertebr Junction Spine. 2019 Jan-Mar;10(1):51-56. doi: 10.4103/jcvjs.JCVJS_8_19.
Thoracolumbar vertebral fractures are common in high-energy trauma and often are associated to other concomitant injuries. Currently, brace and Closed Reduction and Casting (CRC) are the two conservative treatments proposed by literature. Despite CRC was widely used in the past, today brace is preferred. The aim of our study is to evaluate clinical and radiographic outcomes of thoracolumbar type A fractures, not associated with other injuries, treated with CRC.
We retrospectively evaluated all patients treated from 2008 to 2015, with a mean age of 26.69 years (range 15-45). All patients were affected by AO type A fracture: 26 type A1, 17 type A2, and 21 type A3. All patients were evaluated by X-ray, computed tomography, and magnetic resonance imaging. Radiological evaluations included vertebral kyphosis (VK), segmental kyphosis (SK), regional kyphosis (RK) angle, and vertebral ratio (VR) measures. Patients were clinically assessed through visual analog scale, Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Short Form 36 Health Survey.
Seventy-four patients (41 males and 33 females) were included in the study. At follow-up (mean 28.48 months ± 5.16), we found significant improvements in VK ( = 0.000013), SK ( = 0.000455), and RK ( = 0.000016). No significant differences were observed in VR ( = 0.26). Good clinical results were reported in patients in all scores and 90.7% of patients returned to work.
Closed reduction and casting is still a reliable treatment option in selected thoracolumbar fractures without spinal cord involvement. A correct fracture evaluation, patient compliance, and motivation are essentials.
IV.
胸腰椎椎体骨折在高能创伤中很常见，且常伴有其他合并伤。目前，支具和闭合复位与石膏固定（CRC）是文献中提出的两种保守治疗方法。尽管CRC过去被广泛使用，但如今支具更受青睐。我们研究的目的是评估采用CRC治疗的、不伴有其他损伤的胸腰椎A型骨折的临床和影像学结果。
我们回顾性评估了2008年至2015年期间治疗的所有患者，平均年龄为26.69岁（范围15 - 45岁）。所有患者均为AO型A型骨折：26例A1型、17例A2型和21例A3型。所有患者均接受了X线、计算机断层扫描和磁共振成像检查。影像学评估包括椎体后凸（VK）、节段性后凸（SK）、区域后凸（RK）角和椎体比率（VR）测量。通过视觉模拟量表、Oswestry功能障碍指数、Roland - Morris功能障碍问卷和简短健康调查问卷对患者进行临床评估。
74例患者（41例男性和33例女性）纳入研究。在随访时（平均28.48个月±5.16），我们发现VK（ = 0.000013）、SK（ = 0.000455）和RK（ = 0.000016）有显著改善。VR方面未观察到显著差异（ = 0.26）。所有评分的患者均报告了良好的临床结果，90.7%的患者恢复工作。
闭合复位与石膏固定在选定的无脊髓受累的胸腰椎骨折中仍是一种可靠的治疗选择。正确的骨折评估、患者的依从性和积极性至关重要。
IV级
