Abstract
We reviewed 48 patients with thoracolumbar fractures treated conservatively between 1988 and 1999. The average follow-up was 77.5 (31–137) months and average patient age (23 women, 25 men) was 46 (18–76) years. Twenty-nine patients suffered a fall from a height and 13 patients were injured in traffic accidents. Thirty-two patients had compression-type fractures and 16 burst-type fractures. There were no neurological deficits. Twenty-nine patients were treated by orthosis, 13 by body cast and six by bed rest. In addition to pain and functional scoring, we measured a number of radiographic parameters at the time of admission and at latest follow-up and compared the values. In patients with compression fractures there were significant changes in scoliosis angle and wedging index (p<0.05). The mean pain score was 1.66 and mean functional score 1.03. In patients with burst fractures, vertebral index, wedging index and height loss increased after treatment (p<0.05). The mean pain score was 1.26 and functional score 0.93. Compression fractures with kyphosis angle <30° are supposed to be stable and can be treated conservatively. If the kyphosis angle is more than 30°, magnetic resonance imaging (MRI) should be performed, and if the posterior ligamentous complex is damaged, surgery should be considered. In burst fractures, MRI should always be performed and conservative treatment should only be considered if there is no neurological deficit and the ligaments are intact.
Résumé
Nous avons examiné 48 malades avec une fracture dorsolombaire traitée d’une manière conservatrice entre 1988 et 1999. Le suivi moyen était de 77,5 (31–137) mois et l’âge moyen des malades (23 femmes, 25 hommes) était de 46 (18–76) ans. Vingt-neuf malades avaient fait une chute de grande hauteur et 13 malades ont été blessés dans un accident de la circulation. Trente-deux malades avaient des fractures du type compression et 16 fractures du type explosion. Il n’y avait pas de déficit neurologique. Vingt-neuf malades ont été traités par orthèse, 13 par corset plâtré et six par repos au lit. En plus des scores douleur et des scores fonctionnels, nous avons comparé plusieurs paramètres radiographiques entre l’admission et le plus long recul. Chez les malades avec fracture-compression il y avait des changements significatifs dans l’angle de la scoliose et l’index angulaire (p<0.05). Le score moyen de la douleur était 1.66 et le score fonctionnel moyen 1.03. Chez les malades avec fracture-explosion, l’index vertébral, l’index angulaire, et la perte de hauteur ont augmenté après traitement (p<0.05). Le score moyen de la douleur était 1.26 et le score fonctionnel 0.93. Les fractures de type de compression avec angle de cyphose <30° sont supposés être stables et sont traités d’une manière conservatrice. Si l’angle de la cyphose est de plus de 30°, une IRM devrait être exécutée et si le complexe ligamentaire postérieur est endommagé, la chirurgie devrait être envisagée. Dans les fractures du type de explosion, une IMR devrait toujours être exécutée et le traitement conservateur devrait être retenu seulement s’il n’y a aucun déficit neurologique et si les ligaments sont intacts.
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