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首页> 外文期刊>Neurosurgical focus >Timing of surgery in thoracolumbar trauma: Is early intervention safe?
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Timing of surgery in thoracolumbar trauma: Is early intervention safe?

机译：胸腰椎创伤的手术时间：早期干预是否安全？

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摘要

The understanding of the optimal surgical timing for stabilization in thoracolumbar fractures is severely limited. Thoracolumbar spine fractures can be devastating injuries and are often associated with significant morbidity and mortality. The role of early surgical stabilization (within 48-72 hours of injury) as a vehicle to improve outcomes in these patients has generated significant interest. Goals of early stabilization include improved neurological recovery, faster pulmonary recovery, improved pain control, and decreased health care costs. Opponents cite the potential for increased bleeding, hypotension, and the risk of further cord injury as a few factors that weigh against early stabilization. The concept of spinal cord injury and its relationship to surgical timing remains in question. However, when neurological outcomes are eliminated from the equation, certain measures have shown positive influences from prompt surgical fixation. Early fixation of thoracolumbar spine fractures can significantly decrease the duration of hospital stay and the number of days in the intensive care unit. Additionally, prompt stabilization can reduce rates of pulmonary complications. This includes decreased rates of pneumonia and fewer days on ventilator support. Cost analysis revealed as much as $80,000 in savings per patient with early stabilization. All of these benefits come without an increase in morbidity or evidence of increased mortality. In addition, there is no evidence that early stabilization has any ill effect on the injured or uninjured spinal cord. Based on the existing data, early fixation of thoracolumbar fractures has been linked with positive outcomes without clear evidence of negative impacts on the patient's neurological status, associated morbidities, or mortality. These procedures can be viewed as "damage control" and may consist of simple posterior instrumentation or open reductions with internal fixation as indicated. Based on the current literature it is advisable to proceed with early surgical stabilization of thoracolumbar fractures in a well-resuscitated patient, unless extenuating medical conditions would prevent it.
机译：胸腰椎骨折稳定的最佳手术时机的认识受到严格限制。胸腰椎脊柱骨折可能是毁灭性的伤害，并常常与高发病率和高死亡率相关。早期外科手术稳定化（在损伤48-72小时内）作为改善这些患者预后的手段已经引起了极大的兴趣。早期稳定的目标包括改善神经功能，加快肺恢复，改善疼痛控制和降低医疗保健成本。反对者指出，出血，低血压和进一步的脐带受伤的可能性是影响早期稳定的几个因素。脊髓损伤的概念及其与手术时机的关系仍然存在疑问。但是，当从等式中消除神经系统结局时，某些措施已显示出及时进行手术固定的积极影响。胸腰椎脊柱骨折的早期固定可显着减少住院时间和重症监护室的工作天数。此外，迅速稳定可以减少肺部并发症的发生率。这包括降低的肺炎发生率和更少的呼吸机支持天数。成本分析显示，每位患者尽早稳定下来可节省多达80,000美元。所有这些好处都不会增加发病率或增加死亡率的证据。此外，没有证据表明早期稳定对受伤或未受伤的脊髓有不良影响。根据现有数据，胸腰椎骨折的早期固定与积极的预后相关，而没有明确证据表明对患者的神经系统状况，相关的发病率或死亡率产生负面影响。这些程序可被视为“损坏控制”，并且可能包括简单的后路器械或带有所示内固定的切开复位术。根据目前的文献，除非病情减轻，否则建议对早已恢复良好的患者进行胸腰椎骨折的早期手术稳定治疗。

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