胸腰椎骨折的手术与非手术治疗.doc

Seminars inSPINE SURGERYOperative versus Nonoperative Treatment of Thoracolumbar Burst Fractures胸腰段爆裂性骨折的手术与非手术治疗Adam L. Shimer, MD,* and Brian W. Su, MD? High energy injuries to the thoracolumbar (TL) region are commonly encountered and have been described since the time of Hippocrates. Despite this long history and mountains of manuscripts generated on the topic, the optimal care of TL burst fractures remains controversial. There is such great heterogeneity in study designs, inclusion criteria, and interventions used that traditional treatment guidelines require a critical re-evaluation. Many outcome studies have failed to correlate radiographic indicators such a kyphosis, loss of vertebral body height, and canal compromise to long-term clinical outcomes. Furthermore, 3 large prospective, randomized trials have demonstrated outcome equivalency of operative and nonoperative treatment for TL burst fractures without neurological compromise. Surgical intervention remains the standard of care in the setting of progressive neurological deficits, fracture-dislocations, and translational instability. Semin Spine Surg 22:38-43 ? 2010 Elsevier Inc. All rights reserved.KEYWORDS thoracolumbar, burst, fracture, review, evidence-basedHistory历史The thoracolumbar (TL) region of the spine ranges by definition from T11 to L2 inclusively. This area is particularly susceptible to injury because it transitions from a fixed kyphotic spine to a mobile lordotic spine. In 1931, Jones1 described a pure flexion injury to the TL spine that could be anatomically reduced and adequately treated with hyperflexion and cast maintenance in that position. In 1963, approximately 30 years later, Holdsworth2 reexamined TL fractures both as a homage to Watson Jones and because of his overall dissatisfaction with clinical outcomes after treatment of these injuries. The study reported on his experience of treating more than 1000 patients and was later reprinted in JBJS in 1970 as a result of the