Osti O L, Fraser R D, Cornish B L
Department of Orthopaedic Surgery and Trauma, Royal Adelaide Hospital, Australia.
Int Orthop. 1987;11(4):323-9. doi: 10.1007/BF00271308.
A retrospective study was undertaken to analyse and compare the results of Harrington instrumentation with postural reduction and nursing in patients with fractures and fracture-dislocations of the lumbar spine. Thirty patients were treated by postural reduction and nursing, and 38 underwent early surgical reduction and internal fixation with Harrington instrumentation, together with a posterior fusion in three patients and an anterior fusion at the level of the fracture in another two patients. External splintage was used in only one patient in the series. At an average follow up of 5.9 years, bony deformity quantified by angulation, displacement and the vertebral wedge index was greater in the conservative group than in the group treated surgically. No significant difference was observed in comparing the rates of neurological recovery in the two groups. At follow up, patients with no symptoms had less severe bony deformity. Loss of fixation of Harrington instrumentation occurred in 46% of patients treated by this method. The incidence of other complications was not significantly different in the two groups. Despite the unacceptably high rate of local complications, Harrington instrumentation achieved better correction of bony deformity than postural reduction and nursing, prevented progression of deformity and decreased the incidence of symptoms at follow up. This study indicates that in these injuries bony deformity can be satisfactorily corrected by early Harrington instrumentation alone, without spinal fusion and bracing, provided an exacting surgical technique is employed.
进行了一项回顾性研究，以分析和比较哈灵顿器械内固定结合体位复位及护理与腰椎骨折和骨折脱位患者手术结果。30例患者接受体位复位及护理治疗，38例患者早期接受手术复位并用哈灵顿器械内固定，其中3例患者同时行后路融合术，另2例患者在骨折节段行前路融合术。该系列中仅1例患者使用了外部夹板。平均随访5.9年，保守治疗组通过成角、移位和椎体楔形指数量化的骨畸形比手术治疗组更严重。两组神经功能恢复率比较差异无统计学意义。随访时，无症状患者的骨畸形较轻。采用该方法治疗的患者中，46%出现哈灵顿器械内固定松动。两组其他并发症发生率差异无统计学意义。尽管局部并发症发生率高得令人难以接受，但哈灵顿器械内固定比体位复位及护理能更好地矫正骨畸形，防止畸形进展，并降低随访时症状发生率。本研究表明，对于这些损伤，若采用严格的手术技术，仅早期使用哈灵顿器械内固定，无需脊柱融合和支具，即可满意地矫正骨畸形。
