Murat TONBUL, Mehmet Reşat YILMAZ, Mehmet Uğur ÖZBAYDAR, MÜJDAT ADAŞ, Egemen ALTAN

Torakolomber omurga kompresyon kırıklarında konservatif tedavinin uzun dönem sonuçları

Amaç: Kompresyon tipi torakolomber omurga kırıklarında konservatif tedavinin klinik ve radyografik sonuçları değerlendirildi. Çalışma planı: Kırk üç hastadaki (28 erkek, 15 kadın; ort. yaş 39; dağılım 24-54) 47 torakolomber omurga kompresyon kırığı konservatif olarak tedavi edildi. Bütün hastalar düz röntgenografi ve bilgisayarlı tomografi ile değerlendirildi. Denis sınıflamasına göre, kırıkların sekizi tip A, 20’si tip B, 12’si tip C, yedisi tip D olarak değerlendirildi. Kırıkların 30’u L1, beşi L2, 12’si T12 seviyesindeydi. Hiçbir hastada nörolojik defisit saptanmadı. Tedavide iki ay vücut alçısı, buna ek olarak dört ay boyunca torakolumbosakral ortez uygulandı. Tanı sırasında, alçı sonrasında ve son kontrol sırasında çekilen grafilerden lokal kifoz açısı ve sagital indeks ölçüldü. Ağrı ve fonksiyonel durum Denis ve ark.nın skalası ile değerlendirildi. Ortalama takip süresi 7.5 yıl (dağılım 6-11 yıl) idi. Sonuçlar: Lokal kifoz açısı ve sagital indeks alçı tedavisinden önce sırasıyla ortalama 12.6 ve 13.7 derece, alçı yapıldıktan sonra 5.9 ve 7.0 derece ölçüldü (p0.05). Ortalama ağrı skoru 1.4, fonksiyonel skor 1.6 bulundu. Orta veya ciddi derecede sırt ağrısından yakınan dört hastada tedaviden önce, alçı sonrasında ve son kontrolde ölçülen ortalama kifoz açıları sırasıyla 12, 13.5 ve 14.8 derece idi. İki hastada alçıya bağlı aşırı terleme yakınmaları nedeniyle alçı ortez ile değiştirildi. Üç hastada ortez uygulamasına bağlı cilt sorunları lokal tedaviler ile giderildi. Çıkarımlar: Kifoz açısı 30 dereceden az ise, kompresyon kırıkları stabil olarak kabul edilebilir ve konservatif tedaviden tatmin edici klinik sonuç elde edilebilir. Alçı tedavisi sonrası uzun dönemde radyografik parametrelerde iyileşme olmaması hasta fonksiyonlarını olumsuz etkilememektedir.

Anahtar Kelimeler:

Kırık iyileşmesi, Tomografi, x-ışınlı bilgisayarlı, Kırıklar, çökme, Torasik omurga, Tedavi sonucu, Lumbar omurga, Sırt ağrısı, Ortotik aletler, Atel, cerrahi, İzleme çalışmaları, Omurga kırıkları

Long-term results of conservative treatment for thoracolumbar compression fractures

Objectives: We evaluated the radiologic and clinical outcomes of conservative treatment for thoracolumbar compression fractures. Methods: Forty-three patients (28 males, 15 females; mean age 39 years; range 24 to 54 years) were treated conservatively for 47 thoracolumbar compression fractures. All the patients were assessed by plain radiograms and computed tomography. According to the Denis classification, there were eight type A, 20 type B, 12 type C, and seven type D fractures. Involvement was at L1 in 30, L2 in five, and T12 in 12 fractures. There were no neurological deficits. Treatment involved use of a body cast for two months, followed by a thoracolumbosacral orthosis for four months. Radiographically, local kyphosis angle and sagittal index were measured before treatment, after casting, and at the final follow-ups. Pain and functional scales proposed by Denis et al. were also utilized. The mean follow-up was 7.5 years (range 6 to 11 years). Results: The mean local kyphosis angle and sagittal index were measured as 12.6 and 13.7 degrees before treatment, and 5.9 and 7.0 degrees after casting, respectively (p<0.05). However, both did not differ significantly from the baseline at the final measurements (12.7 and 13.9, respectively; p>0.05). The mean pain and functional scores were 1.4 and 1.6, respectively. Four patients had moderate to severe back pain despite mean kyphosis angles of 12 (baseline), 13.5 (after casting), and 14.8 (final). Two patients required substitution of the body cast for orthosis due to excessive sweating, and three patients received local treatment for skin problems secondary to the use of orthosis. Conclusion: If the kyphosis angle is less than 30 degrees, compression fractures are supposed to be stable to be treated conservatively with satisfactory clinical results. Functional results seem to be unaffected from the fact that casting does not improve radiographic parameters in the long-term.

Keywords:

Fracture Healing, Tomography, X-Ray Computed, Fractures, Compression, Thoracic Vertebrae, Treatment Outcome, Lumbar Vertebrae, Back Pain, Orthotic Devices, Casts, Surgical, Follow-Up Studies, Spinal Fractures,

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