Nörolojik bulgusuz torakolomber bölge kompresyon kırıklı çalışan hastalarda konservatif tedavinin rolü

Vertebra kırıklarının % 90ʼı torakolomber bölgede meydana gelir. Stabil olmayan ve nörolojik defisitli kırıklar cerrahi olarak tedavi edilirken, stabil kırıklar genellikle konservatif olarak tedavi edilirler. Kompresyon kırığı olan ve konservatif yöntemlerle tedavi edilen toplam 39 (13 erkek, 26 hasta bayan) hasta çalışmamıza dahil edildi. Tüm hastalar tanı anında direk grafi ve bilgisayarlı tomografi ile değerlendirildi. Lokal kifoz ve sagittal indeks açıları ölçüldü. Hastalara 4 ay süre ile torakolumbosakral hiperekstansiyon ortezi uygulandı. Kontrol grafilerindeki sagittal indeks ve lokal kifoz açıları ölçüldü. Fonksiyonel sonuçlar Denisʼin ağrı ve iş skalası ile değerlendirildi. Hastaların tanı anında ortalama lokal kifoz ve sagittal indeks açıları sırasıyla 20.5° ± 4.8° ve 10.6° ± 3.8° derece, son kontroldeki ortalama lokal kifoz açısı 20.6° ± 4.5° ve ortalama sagittal indeks açısı 10.6° ± 3.8° idi. Bu bulgular değerlendirildiğinde aralarında istatistiksel açıdan anlamlı fark saptanmadı (p>0.05). Hastaların tanı anında ortalama ağrı skoru 3.6 ± 0.5 ve iş dönüş skoru 2.5 ± 0.6 idi. Hastaların son kontrolleri esnasında ölçülen ortalama ağrı skoru 2.2 ± 0.7 işe dönüş skoru ise 1.6 ± 0.5 idi. Bu değerler kıyaslandığında aralarında istatistiksel açıdan anlamlı fark olduğu belirlendi (p

The role of conservative treatment in the working patients with compression fractures of the thoracolumbar region without neural abnormality

Approximately of % 90 vertebral fractures are in the thoracolumbar junction. Patients with unstable fractures and neurological deficits are treated with surgery, stable fractures without neurological deficit are treated with conservative methods. Thirty nine patients (13 male, 26 female) with compression fractures were treated conservatively evaluated retrospectively. All the patients were evaluated with X- rays and computerize tomography. Local kyphosis and sagittal index angles were measured. Thoracolumbosacral hyperextension orthosis was used for all the patients for 4 months. Local kyphosis and sagittal index angles were also measured with control X- rays at the follow up. The functional results were evaluated with Denisʼ pain and work scale. The mean values of the local kyphosis and sagittal index are 20.5° ± 4.8° ve 10.6° ± 3.8° degrees at the first visit. The mean values of the local kyphosis and sagittal index are 20.6° ± 4.5° ve 10.6° ± 3.8° degrees at the last follow up. These values were not statistically significant (p>0.05). The mean values of the pain scale are 3.6 ± 0.5 and the mean values of returning to work scale are 2.5 ± 0.6 at the first visit. There were not any differences between the beginning and the last follow up scales. At the present day the conservative treatment of the compression fractures of thoracolumbar junction is still an alternative treatment method. Finally we think that it is an effective method in the treatment of fractures which are stable compression fractures with local kyphosis and sagittal index under 30 degree in active working patients.Only one of our patients (% 2,6) could not return to his job. Although the adaptation of the patients to the orthosis is difficult; the conservative treatment is an effective and economic treatment method that does not affect returning to the work.

Kaynakça

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