Defino H L, Rodriguez-Fuentes A E
Department of Orthopedics and Trauma Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, SP, Brazil.
Eur Spine J. 1998;7(3):187-94. doi: 10.1007/s005860050054.
Forty-three patients with fractures of the thoracolumbar spine submitted to surgical treatment using the Harms method (dorsoventral operations) were studied prospectively with a follow-up of at least 12 months and evaluated on the basis of clinical and radiologic parameters and in relation to their professional activities. Thirty-five patients (81.3%) were males and eight (18.7%) females, ranging in age from 17 to 67 years (mean 34.08+/-11.51 years). Seven patients (16.2%) presented fractures of more than one vertebra, and associated lesions were present in 15 patients (34.8%). Monosegmental fixation was performed in 7 patients (16.3%), bisegmental fixation in 29 (67.4%), and trisegmental fixation in 7 (16.3%). No patient was submitted to any type of external immobilization during the postoperative period and all patients were allowed to sit up in bed and to walk as soon as their clinical conditions permitted. Thirty-nine patients were followed up for a period ranging from 12 to 36 months (mean 16.58+/-6.83 months). Four patients died during the postoperative period (three of pulmonary embolism and one of septicemia). Forty-two patients sat up in bed between the 2nd and 6th postoperative day, and those who did not present a disabling lesion (Frankel D or E) or other associated lesions walked between the 4th and 10th postoperative day (mean 6.14+/-6.06 days). The neurological signs and symptoms improved in 16 patients (37.3%), were unchanged in 26 (60.4%), and worsened in 1 (2.3%). Twenty-three patients (87.5%) who had no neurological damage (Frankel E) returned to their professional activities after respective periods of disability of 1 month (three patients), 2 months (four patients), 3 months (one patient), 4 months (seven patients), 5-7 months (five patients), 8-12 months (one patient), and more than 12 months (three patients). The ability to work of the 24 patients without neurological damage was 100% in 21, 50% in 2, and zero in 1. The ability to walk of this group of patients was 1-5 km for 4 and more than 5 km for the remaining 20 patients. The complications observed were death (four patients; three cases of pulmonary embolism and one case of septicemia), infection (two patients), Stevens-Johnson syndrome (one patient), and meningitis (one patient). The mean kyphosis of the fractured segment was 22.17 degrees +/- 10.97 degrees preoperatively, 8.55 degrees +/- 6.9 degrees postoperatively, and 10.30 degrees +/- 8.84 degrees on the occasion of late evaluation. No loss of correction occurred in 28 patients (71.8%), a 5 degrees loss was observed in 3 patients (7.6%), a 6 degrees loss in 3 (7.6%), a 7 degrees loss in 3 (7.6%), and a loss of more than 10 degrees in 2 (5.2%).
对43例采用哈姆斯方法（前后路手术）进行胸腰椎骨折手术治疗的患者进行了前瞻性研究，随访至少12个月，并根据临床和影像学参数以及他们的职业活动进行评估。35例（81.3%）为男性，8例（18.7%）为女性，年龄在17至67岁之间（平均34.08±11.51岁）。7例（16.2%）患者存在一个以上椎体骨折，15例（34.8%）有相关损伤。7例（16.3%）患者采用单节段固定，29例（67.4%）采用双节段固定，7例（16.3%）采用三节段固定。术后无患者接受任何类型的外固定，所有患者在临床情况允许后立即允许在床上坐起和行走。39例患者随访12至36个月（平均16.58±6.83个月）。4例患者在术后期间死亡（3例死于肺栓塞，1例死于败血症）。42例患者在术后第2至6天在床上坐起，未出现致残性损伤（Frankel D或E级）或其他相关损伤的患者在术后第4至10天行走（平均6.14±6.06天）。16例患者（37.3%）神经体征和症状改善，26例（60.4%）无变化，1例（2.3%）恶化。23例无神经损伤（Frankel E级）的患者在分别经历1个月（3例）、2个月（4例）、3个月（1例）、4个月（7例）、5至7个月（5例）、8至12个月（1例）和超过12个月（3例）的残疾期后恢复职业活动。24例无神经损伤患者的工作能力，21例为100%，2例为50%，1例为零。该组患者的行走能力，4例为1至5公里，其余20例超过5公里。观察到的并发症有死亡（4例；3例肺栓塞和1例败血症）、感染（2例）、史蒂文斯-约翰逊综合征（1例）和脑膜炎（1例）。骨折节段术前平均后凸为22.17°±10.97°，术后为8.55°±6.9°，后期评估时为10.30°±8.84°。28例患者（71.8%）无矫正丢失，3例患者（7.6%）矫正丢失5°，3例（7.6%）丢失6°，3例（7.6%）丢失7°，2例（5.2%）丢失超过10°。
