Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy
Neurosurgery, Ente Ecclesiastico Ospedale Generale Regionale Francesco Miulli, Acquaviva delle Fonti, Italy.
J Neurointerv Surg. 2022 Feb;14(2):202-206. doi: 10.1136/neurintsurg-2020-017141. Epub 2021 Mar 23.
Both surgery and conservative management are well established treatments for compression fractures of the thoraco-lumbar spine without neurological compromise. This article aims to compare the outcomes of conservative management to those of vertebroplasty, a relatively safe and simple procedure.
102 patients were admitted to our neurosurgical unit between January 2012 and February 2016, presenting with a single-level, post-traumatic A1 or A2 Mager l type fracture, affecting the thoracic-lumbar spine without any neurological deficits. After description of both treatment options, the patients were asked to choose between vertebroplasty or conservative treatment. Accordingly, the patients were allocated into two groups and a prospective non-randomized controlled trial was carried out. The first group (Group A) included 52 patients, treated with bed rest and an orthosis. The second group (Group B) of 50 patients underwent a percutaneous vertebroplasty. Pain intensity (assessed via visual analog scale (VAS)), disability degree (assessed via Oswestry Disability Index), ability to resume work (assessed via Denis work Scale), vertebral body height loss rate, regional kyphosis angle (Cobb's angle), duration of hospitalization and treatment-associated complications, were prospectively recorded in a database and analyzed. Follow ups were planned at 1, 6, and 12 months after the injury.
Group B, compared with group A, showed a faster improvement in VAS score as well as functional ability and return to work. Cobb's angle progression was significantly less in the surgical group. Morbidity, mortality, and complication rate were similar and comparable in both groups without a statistical difference (P<0.05) CONCLUSIONS: Vertebroplasty is a safe and effective treatment in post-traumatic thoracic-lumbar fractures compared with conservative management.
手术和保守治疗对于无神经损伤的胸腰椎压缩性骨折都是成熟的治疗方法。本文旨在比较保守治疗与经皮椎体成形术（一种相对安全、简单的治疗方法）的治疗效果。
2012 年 1 月至 2016 年 2 月期间，共有 102 名患者因单一水平、创伤性 A1 或 A2 Mager l 型骨折入住我们的神经外科病房，这些骨折位于胸腰椎，无任何神经缺损。在描述了两种治疗方案后，让患者在经皮椎体成形术和保守治疗之间做出选择。根据患者的选择，将他们分配到两组并进行前瞻性非随机对照试验。第一组（A 组）有 52 名患者，采用卧床休息和支具治疗。第二组（B 组）有 50 名患者接受了经皮椎体成形术。通过视觉模拟量表（VAS）评估疼痛强度、通过 Oswestry 残疾指数（ODI）评估残疾程度、通过 Denis 工作量表评估恢复工作的能力、通过测量椎体高度丢失率、区域后凸角（Cobb 角）评估椎体再成形术后椎体高度的恢复情况、记录住院时间以及治疗相关并发症，并在数据库中进行前瞻性记录和分析。随访计划在损伤后 1、6 和 12 个月进行。
与 A 组相比，B 组 VAS 评分、功能能力和恢复工作的改善更快。手术组的 Cobb 角进展明显较小。手术组和保守组的发病率、死亡率和并发症发生率相似，无统计学差异（P<0.05）。
与保守治疗相比，经皮椎体成形术是治疗创伤性胸腰椎骨折的一种安全有效的方法。
