Department of Orthopaedics, Traumatology and Rehabilitation, Orthopaedic and Trauma Centre, CTO, Hospital Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy.
School of Orthopaedics and Traumatology, University of the Studies of Turin, Via Zuretti 29, 10126, Turin, Italy.
Musculoskelet Surg. 2021 Apr;105(1):49-59. doi: 10.1007/s12306-020-00644-0. Epub 2020 Feb 5.
To evaluate the outcomes of vertebral stabilisation after acute traumatic thoracolumbar fractures, correlating the outcome with patient clinical data, type and location of fracture, presence of neurological damage, timing of surgical intervention and number of instrumented levels. The results have been evaluated also through the AO classification and AOSIS score.
Retrospective analysis of 101 patients with traumatic thoracolumbar injuries from T3 to L5 operated 2011-2016 by posterior or antero-posterior fixation. The demographic data, trauma dynamics, number and type of fractures, associated lesions, timing of surgery, hospital stay, AOSIS score, RKA, SF-36 and ODI scores, pre- and post-operative neurological condition (ASIA grade), possible complications and re-interventions were evaluated for each patient.
Fractures mainly involved the region between T11 and L2. The probability of medullary involvement increases with the increase in severity of the main fracture type with no relation with the vertebral region. Type B and C fractures were common in the thoracic region and rare in the thoracolumbar junction. ODI and SF-36 scores were significantly better in patients with a lower AOSIS score, specifically in lesions classified as type A, amyelic and with no comorbidity. No difference was found in the clinical scores between thoracic, thoracolumbar and lumbar fractures, nor between male and female patients. None of the 10 patients with ASIA A lesion at presentation achieved any degree of recovery: 50% of them had a thoracic lesion. Re-intervention rate was 15%. Hospital stay was significantly higher in patients with type C fractures, and complication rate was on average 14% (7% in type A fractures, 16% in B and 25% in C).
This study confirmed the validity of the posterior approach in the surgical treatment of thoracolumbar fractures. Outcomes and complication risks are related to fracture severity. Surgical treatment can be recommended even with an AOSIS score of two or three. The combined antero-posterior approach could be useful in cases with LSC > 8, especially in the thoracolumbar region. The degree of neurological recovery depends on fracture type, location, ASIA score and presence of comorbidities. Early intervention in myelic patients allows for a better prognosis. Level of evidence III retrospective case series.
评估急性创伤性胸腰椎骨折后脊柱稳定的结果，并将结果与患者临床数据、骨折类型和部位、神经损伤情况、手术干预时机和置钉节段数量相关联。结果还通过 AO 分类和 AOSIS 评分进行评估。
回顾性分析 2011 年至 2016 年间采用后路或前后联合固定治疗的 101 例创伤性胸腰椎损伤患者（T3 至 L5）。评估每位患者的人口统计学数据、创伤动力学、骨折数量和类型、合并损伤、手术时机、住院时间、AOSIS 评分、RKA、SF-36 和 ODI 评分、术前和术后神经状况（ASIA 分级）、可能的并发症和再次干预。
骨折主要发生在 T11 和 L2 之间。脊髓受累的概率随着主要骨折类型严重程度的增加而增加，但与椎体区域无关。B 型和 C 型骨折在胸段常见，而在胸腰椎交界处罕见。AOSIS 评分较低的患者 ODI 和 SF-36 评分显著更好，特别是在 A 型损伤、无骨髓炎且无合并症的患者中。胸段、胸腰椎段和腰椎段骨折患者的临床评分无差异，男女患者也无差异。在出现时 ASIA A 级病变的 10 名患者中，没有任何程度的恢复：50%的患者有胸段病变。再干预率为 15%。C 型骨折患者的住院时间明显更长，并发症发生率平均为 14%（A 型骨折 7%，B 型 16%，C 型 25%）。
本研究证实后路入路在胸腰椎骨折的手术治疗中的有效性。结果和并发症风险与骨折严重程度相关。即使 AOSIS 评分为 2 或 3，也可以推荐手术治疗。前后联合入路在 LSC>8 的情况下可能有用，特别是在胸腰椎区域。神经恢复程度取决于骨折类型、部位、ASIA 评分和合并症的存在。早期干预脊髓患者可获得更好的预后。证据水平 III 回顾性病例系列。
