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首页> 外文期刊>Neurosurgical focus >Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: A systematic review
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Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: A systematic review

机译：胸腰椎外伤性骨折的手术和非手术不良事件：系统评价

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Object: Thoracolumbar spine injuries are commonly encountered in patients with trauma, accounting for almost 90% of all spinal fractures. Thoracolumbar burst fractures comprise a high percentage of these traumatic fractures (45%), and approximately half of the patients with this injury pattern are neurologically intact. However, a debate over complication rates associated with operative versus nonoperative management of various thoracolumbar fracture morphologies is ongoing, particularly concerning those patients presenting without a neurological deficit. Methods: A MEDLINE search for pertinent literature published between 1966 and December 2013 was conducted by 2 authors (G.G. and R.D.), who used 2 broad search terms to maximize the initial pool of manuscripts for screening. These terms were "operative lumbar spine adverse events" and "nonoperative lumbar spine adverse events." Results: In an advanced MEDLINE search of the term "operative lumbar spine adverse events" on January 8, 2014, 1459 results were obtained. In a search of "nonoperative lumbar spine adverse events," 150 results were obtained. After a review of all abstracts for relevance to traumatic thoracolumbar spinal injuries, 62 abstracts were reviewed for the "operative" group and 21 abstracts were reviewed for the "nonoperative" group. A total of 14 manuscripts that met inclusion criteria for the operative group and 5 manuscripts that met criteria for the nonoperative group were included. There were a total of 919 and 436 patients in the operative and nonoperative treatment groups, respectively. There were no statistically significant differences between the groups with respect to age, sex, and length of stay. The mean ages were 43.17 years in the operative and 34.68 years in the nonoperative groups. The majority of patients in both groups were Frankel Grade E (342 and 319 in operative and nonoperative groups, respectively). Among the studies that reported the data, the mean length of stay was 14 days in the operative group and 20.75 in the nonoperative group. The incidence of all complications in the operative and nonoperative groups was 300 (32.6%) and 21 (4.8%), respectively (p = 0.1065). There was no significant difference between the 2 groups with respect to the incidence of pulmonary, thromboembolic, cardiac, and gastrointestinal complications. However, the incidence of infections (pneumonia, urinary tract infection, wound infection, and sepsis) was significantly higher in the operative group (p = 0.000875). The incidence of instrumentation failure and need for revision surgery was 4.35% (40 of 919), a significant morbidity, and an event unique to the operative category (p = 0.00396). Conclusions: Due to the limited number of high-quality studies, conclusions related to complication rates of operative and nonoperative management of thoracolumbar traumatic injuries cannot be definitively made. Further prospective, randomized studies of operative versus nonoperative management of thoracolumbar and lumbar spine trauma, with standardized definitions of complications and matched patient cohorts, will aid in properly defining the risk-benefit ratio of surgery for thoracolumbar spine fractures.
机译：目的：胸腰椎脊柱损伤常见于外伤患者中，几乎占所有脊柱骨折的90％。胸腰椎爆裂骨折在这些创伤性骨折中占很高的比例（45％），并且大约一半患有这种损伤方式的患者在神经方面是完整的。然而，关于与各种胸腰椎骨折形态的手术治疗和非手术治疗相关的并发症发生率的争论仍在进行中，特别是对于那些没有神经功能缺损的患者。方法：由2位作者（G.G.和R.D.）对1966年至2013年12月之间发表的相关文献进行MEDLINE搜索，他们使用2个广泛的搜索词来最大程度地筛选手稿。这些术语是“手术腰椎不良事件”和“非手术腰椎不良事件”。结果：在2014年1月8日的MEDLINE高级检索中，“手术腰椎不良事件”一词获得了1459个结果。在搜索“非手术性腰椎不良事件”中，获得了150个结果。在审查了所有与创伤性胸腰椎脊髓损伤相关的摘要之后，对“手术”组审查了62个摘要，对“非手术”组审查了21个摘要。符合手术组纳入标准的14篇手稿和符合非手术组标准的5篇手稿。手术组和非手术组分别有919例和436例患者。两组之间在年龄，性别和住院时间方面无统计学差异。手术组平均年龄为43.17岁，非手术组为34.68岁。两组中的大多数患者均为Frankel E级（手术组和非手术组分别为342和319）。在报告数据的研究中，手术组的平均住院天数为14天，非手术组为20.75。手术组和非手术组所有并发症的发生率分别为300（32.6％）和21（4.8％）（p = 0.1065）。两组之间在肺部，血栓栓塞，心脏和胃肠道并发症的发生率方面无显着差异。但是，手术组的感染（肺炎，尿路感染，伤口感染和败血症）的发生率明显更高（p = 0.000875）。仪器故障和需要进行翻修手术的发生率为4.35％（919例中的40例），高发病率和一个仅属于手术类别的事件（p = 0.00396）。结论：由于高质量研究的数量有限，因此无法确切地得出与胸腰部创伤性损伤的手术和非手术处理并发症发生率有关的结论。对胸腰椎和腰椎创伤进行手术与非手术处理的进一步前瞻性，随机研究，包括并发症的标准化定义和匹配的患者队列，将有助于正确定义胸腰椎骨折手术的风险收益率。

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