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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・Despi
2、tethislonghistoryandmountainsofmanuscriptsgeneratedonthetopic,theoptimalcareofTLburstfracturesremainscontroversial.Thereissuchgreatheterogeneityinstudydesigns,inclusioncriteria,andinterventionsusedthattraditionaltreatmentguidelinesrequireacriticalre-evalua
3、tion.Manyoutcomestudieshavefailedtocorrelateradiographicindicatorssuchakyphosis,lossofvertebralbodyheight,andcanalcompromisetolong-termclinicaloutcomes・Furthermore,3largeprospective,randomizedtrialshavedemonstratedoutcomeequivalencyofoperativeandnonoperati
4、vetreatmentforTLburstfractureswithoutneurologicalcompromise・Surgicalinterventionremainsthestandardofcareinthesettingofprogressiveneurologicaldeficits,fracture-dislocations,andtranslationalinstability.SeminSpineSurg22:38-43©2010BsevierInc.Allrightsreserved.
5、KEYWORDSthoracolumbar,burst,fracture,review,evidence-basedHistory历史Thethoracolumbar(TL)regionofthespinerangesbydefinitionfromT11toL2inclusively.Thisareaisparticularlysusceptibletoinjurybecauseittransitionsfromafixedkyphoticspinetoamobilelordoticspine.In193
6、1,Jones1describedapureflexioninjurytotheTLspinethatcouldbeanatomicallyreducedandadequatelytreatedwithhyperflexionandcastmaintenanceinthatposition.In1963,approximately30yearslater,Holdsworth2reexaminedTLfracturesbothasahomagetoWatsonJonesandbecauseofhisover
7、alldissatisfactionwithclinicaloutcomesaftertreatmentoftheseinjuries・Thestudyreportedonhisexperienceoftreatingmorethan1000patientsandwaslaterreprintedinJBJSin1970asaresultoftheexcitementitgeneratedfromlectureshegaveattheAlbertduFbntCenterin1969,thesameyearo
8、fhisdeath.Holdsworthdescribedthe"two-column^modelofTLstabilityemphasizingtheimportanceoftheposteriorligamentouscomplex(PLC),whichhedefinedasagroupofligamentscomposedoftheposteriorfacetjoint,intraspinousligame
