Weinstein J N, Collalto P, Lehmann T R
Department of Orthopaedic Surgery, University of Iowa, Iowa City.
Spine (Phila Pa 1976). 1988 Jan;13(1):33-8. doi: 10.1097/00007632-198801000-00008.
This report addresses the long-term results of nonoperative treatment for fractures of the thoracolumbar spine. Forty-two patients meeting specified inclusion criteria were contacted and completed questionnaires. In all cases, nonoperative treatment was the only treatment received. The average time from injury to follow-up was 20.2 years (range, 11 to 55 years). The average age at follow-up was 43 years (range, 28 to 70 years). There were 31 men and 11 women in this series. Seventy-one percent of the injuries were the result of motor vehicle accidents. The most common sites of injury were T12-L2, which accounted for 64% of the injuries. Seventy-eight percent of the patients had no neurologic deficits at the time of injury. At follow-up, the average back pain score was 3.5, with 0 being no pain at all and 10 being very severe pain. No patient demonstrated a decrease in their neurologic status at follow-up, and no patient required narcotic medication for pain control. Eighty-eight percent of patients were able to work at their usual level of activity. Follow-up radiographs revealed an average kyphosis angle of 26.4 degrees in flexion and 16.8 degrees in extension. The degree of kyphosis did not correlate with pain or function at follow-up. Based on this review, nonoperative treatment of thoracolumbar burst fractures remains as a viable alternative in patients without neurologic deficit and can lead to acceptable long-term results.
本报告阐述了胸腰椎骨折非手术治疗的长期结果。联系了42名符合特定纳入标准的患者并完成了问卷调查。在所有病例中，非手术治疗是唯一接受的治疗方式。从受伤到随访的平均时间为20.2年（范围为11至55年）。随访时的平均年龄为43岁（范围为28至70岁）。该系列中有31名男性和11名女性。71%的损伤是机动车事故所致。最常见的损伤部位是T12-L2，占损伤的64%。78%的患者在受伤时无神经功能缺损。随访时，平均背痛评分为3.5分，0分为无疼痛，10分为非常严重的疼痛。随访时没有患者神经功能状态下降，也没有患者需要使用麻醉药物控制疼痛。88%的患者能够以其平常的活动水平工作。随访X线片显示，平均后凸角在屈曲时为26.4度，伸展时为16.8度。随访时后凸程度与疼痛或功能无关。基于本综述，对于无神经功能缺损的患者，胸腰椎爆裂骨折的非手术治疗仍是一种可行的选择，并且可带来可接受的长期结果。
