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1、SeminarsinSPINESURGERYOperativeversusNonoperativeTreatmentofThoracolumbarBurstFractures胸腰段爆裂性骨折的手术与非手术治疗AdamL.Shimer,MD,*andBrianW.Su,MD†Highenergyinjuriestothethoracolumbar(TL)regionarecommonlyencounteredandhavebeendescribedsincethetimeofHippocrates.Despitet
2、hislonghistoryandmountainsofmanuscriptsgeneratedonthetopic,theoptimalcareofTLburstfracturesremainscontroversial.Thereissuchgreatheterogeneityinstudydesigns,inclusioncriteria,andinterventionsusedthattraditionaltreatmentguidelinesrequireacriticalre-evaluation.M
3、anyoutcomestudieshavefailedtocorrelateradiographicindicatorssuchakyphosis,lossofvertebralbodyheight,andcanalcompromisetolong-termclinicaloutcomes.Furthermore,3largeprospective,randomizedtrialshavedemonstratedoutcomeequivalencyofoperativeandnonoperativetreatme
4、ntforTLburstfractureswithoutneurologicalcompromise.Surgicalinterventionremainsthestandardofcareinthesettingofprogressiveneurologicaldeficits,fracture-dislocations,andtranslationalinstability.SeminSpineSurg22:38-43©2010ElsevierInc.Allrightsreserved.KEYWORDStho
5、racolumbar,burst,fracture,review,evidence-basedHistory历史Thethoracolumbar(TL)regionofthespinerangesbydefinitionfromT11toL2inclusively.Thisareaisparticularlysusceptibletoinjurybecauseittransitionsfromafixedkyphoticspinetoamobilelordoticspine.In1931,Jones1descri
6、bedapureflexioninjurytotheTLspinethatcouldbeanatomicallyreducedandadequatelytreatedwithhyperflexionandcastmaintenanceinthatposition.In1963,approximately30yearslater,Holdsworth2reexaminedTLfracturesbothasahomagetoWatsonJonesandbecauseofhisoveralldissatisfactio
7、nwithclinicaloutcomesaftertreatmentoftheseinjuries.Thestudyreportedonhisexperienceoftreatingmorethan1000patientsandwaslaterreprintedinJBJSin1970asaresultoftheexcitementitgeneratedfromlectureshegaveattheAlbertduPontCenterin1969,thesameyearofhisdeath.Holdsworth
8、describedthe“two-column”modelofTLstabilityemphasizingtheimportanceoftheposteriorligamentouscomplex(PLC),whichhedefinedasagroupofligamentscomposedoftheposteriorfacetjoint,intraspinousligam
