José Lucas Miotto, Coury Pedro, Meves Robert
Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
Grupo de Coluna, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ortop (Sao Paulo). 2023 Mar 24;58(1):58-66. doi: 10.1055/s-0042-1756322. eCollection 2023 Feb.
To evaluate the spinopelvic alignment in patients with thoracolumbar burst fracture (TBF) without neurological deficit treated nonsurgically and surgically in a tertiary reference trauma hospital. Retrospective cross-sectional study of patients with single level, type A3 and A4 AOSpine TBF only of the thoracolumbar region. Analysis of clinical data, low back pain (visual analogue scale [VAS]), Denis Pain Scale, quality of life (SF-36), sagittal (TC, TLC, LL, SVA) and spinopelvic (IP, PV, SI, PI-LL) radiographic parameters of patients treated surgically and nonsurgically. A total of 50 individuals with an average age of 50 years old with a mean follow-up of 109 months (minimum of 19 and maximum of 306 months) were evaluated. There was a significant difference between treatments for the Denis Work Scale ( = 0.046) in favor of nonsurgical treatment. There was no significant difference between the treatments for lower back pain VAS and Denis Pain Scale ( = 0.468 and = 0.623). There was no significant difference between treatments in any of the domains evaluated with the SF-36 ( > 0.05). Radiographic parameters were not different between the analyzed groups; however, all radiographic parameters showed significant difference between the population considered asymptomatic, except for pelvic incidence ( < 0.005). The spinopelvic alignment was normal in patients with TBF without neurological deficit treated nonsurgically and surgically after a minimum follow-up of 19 months. However, they presented a higher mean pelvic version and discrepancy between lumbar lordosis and pelvic incidence when compared with the reference values of the Brazilian population.
在一家三级创伤专科医院，评估非手术和手术治疗的无神经功能缺损的胸腰椎爆裂骨折（TBF）患者的脊柱骨盆对线情况。 对仅为胸腰段单节段、A3型和A4型AOSpine TBF患者进行回顾性横断面研究。分析手术和非手术治疗患者的临床数据、腰痛（视觉模拟量表[VAS]）、Denis疼痛量表、生活质量（SF-36）、矢状面（胸椎后凸[TC]、胸腰段后凸[TLC]、腰椎前凸[LL]、矢状面垂直轴[SVA]）和脊柱骨盆（骨盆倾斜角[IP]、骨盆入射角[PV]、骶骨倾斜角[SI]、骨盆倾斜角与腰椎前凸差值[PI-LL]）影像学参数。共评估了50例平均年龄50岁、平均随访109个月（最短19个月，最长306个月）的患者。Denis工作量表的治疗效果之间存在显著差异（P = 0.046），非手术治疗更具优势。下腰痛VAS和Denis疼痛量表的治疗效果之间无显著差异（P = 0.468和P = 0.623）。SF-36评估的任何领域的治疗效果之间均无显著差异（P>0.05）。分析组之间的影像学参数无差异；然而，除骨盆入射角外，所有影像学参数在无症状人群中均显示出显著差异（P<0.005）。 非手术和手术治疗的无神经功能缺损的TBF患者在最短随访19个月后，脊柱骨盆对线正常。然而，与巴西人群的参考值相比，他们的平均骨盆倾斜角更高，腰椎前凸与骨盆入射角之间的差异更大。
