Ulus Travma Acil Cerrahi Derg. 2020; 26(5): 805-810 | DOI: 10.14744/tjtes.2020.30524

Torakolomber yaralanma sýnýflamasý ve ciddiyet skoru 4 (TLICS = 4) olan torakolomber vertebra kýrýklarýnýn yönetimi: Cerrahi mi, konservatif tedavi mi?

Evren Karaali¹, Osman Ciloglu¹, Altuð Duramaz², Aslihan Kusvuran Ozkan³, Timur Ekiz^4
1Adana Þehir Hastanesi, Ortopedi Ve Travmatoloji Kliniði, Adana
²Bakýrköy Dr. Sadi Konuk Eðitim Ve Araþtýrma Hastanesi, Ortopedi Ve Travmatoloji Kliniði, Ýstanbul
³Özülkü Týp Merkezi, Fizik Tedavi Ve Rehabilitasyon Kliniði, Adana
⁴Ýstanbul Gedik Üniversitesi Saðlýk Bilimleri Fakültesi, Fizik Tedavi Ve Rehabilitasyon Ana Bilim Dalý, Ýstanbul

AMAÇ: Torakolomber yaralanma sýnýflamasý ve ciddiyet skoru 4 (TLICS = 4) olan nörolojik intakt torakolomber vertebra kýrýklý hastalarda cerrahi tedavi ve korse tedavisinin klinik ve radyografik sonuçlarýnýn karþýlaþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Travmatik torakolomber kýrýk (T11-L2), TLICS 4 skoru ve en az 24 ay takip edilen hastalar alýndý. Hastalar cerrahi ve korse gruplarýna ayrýldý. Gruplar klinik ve demografik özellikler, lokal kifoz açýlarý (LKA), vertebra yükseklik kaybý yüzdesi (VYK), Oswestry Engellilik Ýndeksi (ODI), Visual Analog Skala (VAS) ve iþe geri dönme süresi açýsýndan karþýlaþtýrýldý.
BULGULAR: Cerrahi grubunda 74 hasta (71 erkek, 3 kadýn), korse grubunda 76 hasta (58 erkek, 18 kadýn) vardý. Cerrahi grupta ameliyat sonrasý ilk altý ay içinde VAS skorlarýnda daha iyi olsa da 24. ayda gruplar arasýnda anlamlý bir fark gözlenmedi (sýrasýyla, p<0.001 ve p=0.270). ODI, LKA ve VYK cerrahi grubunda anlamlý olarak düþüktü (sýrasýyla, p<0.001, p<0.001 ve p<0.001). Ýþe geri dönüþ süresi ameliyat grubunda anlamlý olarak daha kýsa idi (p<0.001).
TARTIÞMA: Torakolomber kýrýklarý olan nörolojik olarak intakt TLICS 4 hastalarýn cerrahi tedavisinin, korseye göre daha iyi klinik ve radyografik sonuçlarý olduðunu saptandý. Ayrýca, hastalarýn iþe dönüþ sürelerinin cerrahi tedavi ile kýsaltýldýðý gösterildi. TLICS 4 torakolomber vertebral kýrýklarýn tedavisinde cerrahi tedavi ilk ve uygun seçenek olarak görünmektedir.

Anahtar Kelimeler: Cerrahi tedavi, klinik ve radyolojik sonuçlar, spinal korse; TLICS; torakolomber kýrýklar.

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Management of thoracolumbar injury classification and severity score of 4 (TLICS=4) thoracolumbar vertebra fractures: Surgery versus conservative treatment

Evren Karaali¹, Osman Ciloglu¹, Altuð Duramaz², Aslihan Kusvuran Ozkan³, Timur Ekiz^4
1Department of Orthopedics and Traumatology, Adana City Hospital, Adana-Turkey
²Department of Orthopedics and Traumatology, Bakýrköy Dr. Sadi Konuk Training and Research Hospital, Ýstanbul-Turkey
³Department of Physical and Rehabilitation Medicine, Özülkü Medical Center, Adana-Turkey
⁴Department of Physical Therapy and Rehabilitation, Ýstanbul Gedik University Faculty of Health Sciences, Ýstanbul-Turkey

BACKGROUND: This study aims to compare clinical and radiographic outcomes of surgical treatment and conservative treatment with bracing in neurologically intact patients with score 4 of TLICS thoracolumbar vertebra fractures.
METHODS: Patients with traumatic thoracolumbar junction fractures (T11-L2), the score of TLICS 4, and minimum 24-month follow-up were included in this study. Patients were divided into surgery and bracing groups. The groups were compared concerning clinical and demographical features, local kyphotic angles (LKA), vertebra height loss percentage (VHL), Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and time to return to work.
RESULTS: There were 74 patients (71 males, 3 females) in the surgery group and 76 patients (58 males, 18 females) in the bracing group. Although the surgery group showed better improvement in VAS scores within six months postoperatively, no significant difference was observed at the 24th-month evaluation (p<0.001 and p=0.270, respectively). ODI, LKA and VHL were significantly lower in the surgery group (p<0.001, p<0.001 and p<0.001, respectively). In addition, return to work was significantly earlier in the surgery group (p<0.001).
CONCLUSION: The findings obtained in this study suggest that the surgical treatment for TLICS 4 patients with thoracolumbar fractures has better clinical and radiographic outcomes than the bracing. Moreover, returning time to the work of patients is shortened with surgical treatment. The surgical treatment seems to be the first and the appropriate choice in the management of TLICS 4 thoracolumbar vertebral fractures.

Keywords: Clinical and radiological outcomes, spinal bracing; surgical treatment; thoracolumbar fractures; TLICS.

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