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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,MDtHighenergyinjuriestothethoracolumbar(TL)regionarecommonlyencounteredandhavebeendescribedsincethetimeofHippocrates・
2、Despitethislonghistoryandmountainsofmanuscriptsgeneratedonthetopic,theoptimalcareofTLburstfracturesremainscontroversial.Thereissuchgreatheterogeneityinstudydesigns,inclusioncriteria,andinterventionsusedthattraditionaltreatmentguidelinesrequireacritica
3、lre-evaluation.Manyoutcomestudieshavefailedtocorrelateradiographicindicatorssuchakyphosis,lossofvertebralbodyheight,andcanalcompromisetoIong-termclinicaloutcomes・Furthermore,3largeprospective,randomizedtrialshavedemonstratedoutcomeequivalencyofoperati
4、veandnoinoperativetreatmentforTLburstfractureswithoutneurologicalcompromise.Surgicalinterventionremainsthestandardofcareinthesettingofprogressiveneurologicaldeficits,fracture-dislocations,andtranslationalinstability.SeminSpineSurg22:38-43©2010BsevierI
5、nc.Allrightsreserved・KEYWORDSthoracolumbar,burst,fracture,review,evidence-basedHistory历史Thethoracolumbar(TL)regionofthespinerangesbydefinitionfromT11toL2inclusively.Thisareaisparticularlysusceptibletoinjurybecauseittransitionsfromafixedkyphoticspineto
6、amobilelordoticspine.In1931,JonesldescribedapureflexioninjurytotheTLspinethatcouldbeanatomicallyreducedandadequatelytreatedwithhyperflexionandcastmaintenanceinthatposition.In1963,approximately30yearslater,Holdsworth2reexaminedTLfracturesbothasahomaget
7、oWatsonJonesandbecauseofhisoveralldissatisfactionwithclinicaloutcomesaftertreatmentoftheseinjuries.Thestudyreportedonhisexperienceoftreatingmorethan1000patientsandwaslaterreprintedinJBJSin1970asaresultoftheexcitementitgeneratedfromlectureshegaveattheA
8、lbertduFbnt8nterin1969,thesameyearofhisdeath・Holdsworthdescribedtherwocolumn"modelofTLstabilityemphasizingtheimportaneeoftheposteriorligamentouscomplex(PLC),whichhedefinedasagroupofligamentscomposedoftheposteriorfacetjoint,intraspinousligament
