and Lumbar Spine Fractures and Dislocations 胸腰椎骨折脱位课件.ppt

62% showing good or excellent outcome 38% showing moderate or poor outcome Significant effects on clinical outcome: Load-sharing classification, posttraumatic kyphosis overall ? lumbopelvic lordosis Surgical reconstruction appropriate treatment in more severe fractures Koller, Eur Spine J, 2008 Evaluated 21 pts; 9.5 yr f/u Surgical Management of Thoracolumbar Injuries Unstable burst fractures Purely ligamentous Facet dislocations Translational injuries Neurologic deficit Delayed diagnosis in 28 pts (19%) Differences b/w surgical non: ? in pulmonary complications length of hospital stay in non-op pts. Surgical pts had highly significantly less pain Radiographic studies should be performed Choice of treatment in pts with multiple injuries is not different from that in pts with no asscd injuries Dai, J Trauma, 2004 147 pts w/acute thoracolumbar fractures: 1988 to 1997 Min. 3yr f/u; 4 pts died during hospital stay Lack of evidence demonstrating superiority of one approach over the other No evidence linking posttraumatic kyphosis to clinical outcomes Strong need for improved clinical research methodology to be applied to this patient population Thomas, J Neurosurg Spine, 2006 Evaluated scientific literature on operative non-op treatments Reviewed 37 pts Accuracy of plain radiographs improved w/experience of observers Impact of disagreement on treatment plan was significant Plain radiography alone is not adequate Dai, Spine, 2008 Extended anterolateral fixation is biomechanically comparable to circumferential fusion Extension of anterior instrumentation fusion 1-level above and below the unstable segment can result in near equivalent stability to a 2-stage circumferential procedure Acosta, J Neurosurg Spine, 2008 Biomechanical comparison of 3 fixation techniques for unstable thoracolumbar fractures. Induced at L1: 1) Short-segment anterolateral fixation 2) Circumferential fixation 3) Extended anterolateral fixation Angular stable plate system showed higher