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首页> 外文期刊>Neurosurgical focus >Evidence-based management of traumatic thoracolumbar burst fractures: A systematic review of nonoperative management
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Evidence-based management of traumatic thoracolumbar burst fractures: A systematic review of nonoperative management

机译：创伤性胸腰椎爆裂骨折的循证管理：非手术治疗的系统评价

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Object: The overall evidence for nonoperative management of patients with traumatic thoracolumbar burst fractures is unknown. There is no agreement on the optimal method of conservative treatment. Recent randomized controlled trials that have compared nonoperative to operative treatment of thoracolumbar burst fractures without neurological deficits yielded conflicting results. By assessing the level of evidence on conservative management through validated methodologies, clinicians can assess the availability of critically appraised literature. The purpose of this study was to examine the level of evidence for the use of conservative management in traumatic thoracolumbar burst fractures. Methods: A comprehensive search of the English literature over the past 20 years was conducted using PubMed (MEDLINE). The inclusion criteria consisted of burst fractures resulting from a traumatic mechanism, and fractures of the thoracic or lumbar spine. The exclusion criteria consisted of osteoporotic burst fractures, pathological burst fractures, and fractures located in the cervical spine. Of the studies meeting the inclusion/exclusion criteria, any study in which nonoperative treatment was used was included in this review. Results: One thousand ninety-eight abstracts were reviewed and 447 papers met inclusion/exclusion criteria, of which 45 were included in this review. In total, there were 2 Level-I, 7 Level-II, 9 Level-III, 25 Level-IV, and 2 Level-V studies. Of the 45 studies, 16 investigated conservative management techniques, 20 studies compared operative to nonoperative treatments, and 9 papers investigated the prognosis of conservative management. Conclusions: There are 9 high-level studies (Levels I-II) that have investigated the conservative management of traumatic thoracolumbar burst fractures. In neurologically intact patients, there is no superior conservative management technique over another as supported by a high level of evidence. The conservative technique can be based on patient and surgeon preference, comfort, and access to resources. A high level of evidence demonstrated similar functional outcomes with conservative management when compared with open surgical operative management in patients who were neurologically intact. The presence of a neurological deficit is not an absolute contraindication for conservative treatment as supported by a high level of evidence. However, the majority of the literature excluded patients with neurological deficits. More evidence is needed to further classify the appropriate burst fractures for conservative management to decrease variables that may impact the prognosis.
机译：目的：创伤性胸腰椎爆裂性骨折患者的非手术治疗的总体证据尚不清楚。保守治疗的最佳方法尚无共识。最近的随机对照试验对非腰椎胸腰椎爆裂性骨折的非手术治疗与手术治疗进行了比较，得出了矛盾的结果。通过使用经过验证的方法来评估保守治疗的证据水平，临床医生可以评估经过严格评估的文献的可用性。这项研究的目的是检查在创伤性胸腰椎爆裂骨折中采用保守治疗的证据水平。方法：使用PubMed（MEDLINE）对过去20年的英语文献进行全面搜索。纳入标准包括外伤机制引起的爆裂性骨折，胸椎或腰椎骨折。排除标准包括骨质疏松性爆裂性骨折，病理性爆裂性骨折以及位于颈椎的骨折。在符合纳入/排除标准的研究中，使用非手术治疗的任何研究均包括在本评价中。结果：审查了198篇摘要，符合纳入/排除标准的447篇论文，其中45篇被纳入本综述。总共有2项I级，7项II级，9项III级，25项IV级和2项V级研究。在这45项研究中，有16项研究了保守治疗技术，有20项研究比较了手术治疗与非手术治疗，还有9篇论文研究了保守治疗的预后。结论：有9项高级研究（I-II级）研究了创伤性胸腰椎爆裂骨折的保守治疗。在神经系统完整的患者中，没有证据表明存在比其他方法更好的保守治疗方法。保守技术可以基于患者和医生的喜好，舒适度以及对资源的访问。大量证据表明，与神经功能完好的患者进行开放式手术相比，保守治疗具有相似的功能结局。有大量证据支持，神经功能缺损并不是保守治疗的绝对禁忌症。但是，大多数文献排除了神经功能缺损的患者。需要更多的证据来进一步分类适当的爆裂骨折，以进行保守治疗，以减少可能影响预后的变量。

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