Zusammenfassung
Hintergrund
Traumatische Frakturen der nicht degenerativ veränderten thorakalen und lumbalen Wirbelsäule treten bei Verletzungen mit hoher kinetischer Energie auf. Zur Einteilung wird aktuell die AO-Spine-Klassifikation genutzt.
Ziel der Arbeit
Die Darstellung der Kriterien, die eine konservative Behandlung mittels orthetischer Versorgung erlauben, und der Vergleich mit Behandlungsergebnissen konkurrierender Methoden sind Ziele dieser Arbeit.
Material und Methoden
Es erfolgte eine Literaturrecherche nach dem PRISMA-Protokoll (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane und Google Scholar. Es wurden 118 potenziell bedeutsame Publikationen gefunden, von denen 16 prospektive Arbeiten wie folgt analysiert wurden: Das Verzerrungsrisiko wurde mit dem RoB2-Tool (Cochrane Risk of Bias Tool in der zweiten Version) bzw. nach ROBINS‑I (Risk Of Bias In Non-randomised Studies of Interventions) sowie der Evidenzlevel nach AHCPR (Agency for Health Care Policy and Research) beurteilt.
Ergebnisse
Bei traumatischen Frakturen (AOS-Typen A0–A3) der nicht degenerativ veränderten thorakalen und lumbalen Wirbelsäule ohne Operationsindikation ist die konservative Behandlung mit Analgesie, Physiotherapie und früher Mobilisation sinnvoll und einer Orthese nicht unterlegen. Eine operative Therapie führte auch bei konservativ behandelbaren Frakturen früher zu verbesserter Funktionalität und Schmerzempfindung. Langzeitvergleiche zeigten keine Unterschiede im funktionellen Ergebnis. Die Erfassung des neurologischen Defizites, des funktionellen Behandlungserfolges und des Kyphosewinkels erfolgten vielfältig, was die Vergleichbarkeit der Studien reduzierte. Die Studienqualität ist bei Evidenzlevel Ib–IIa häufig mit hohem Risiko für Verzerrungen eingeschränkt.
Diskussion
Eine Orthese kann bei diesen Erkrankungsbildern eine sinnvolle Ergänzung im Rahmen der konservativen Schmerztherapie sein. Als Monotherapie ist die Orthesenbehandlung nicht zu empfehlen.
Abstract
Background
Trauma-related fractures of the thoracic and lumbar spine occur after exposure to high kinetic energy. To assign patients to the correct kind of treatment the AO spine classification is used.
Objective
The aim was to describe the role of orthotic devices in the treatment of thoracic and lumbar fractures in the nondegenerative spine.
Material and methods
A review of the literature was carried out according to the PRISMA protocol (Preferred Reporting Items for Systematic reviews and Meta-Analyses) in PubMed, ScienceDirect, Cochrane and Google.Scholar. A total of 118 potentially important publications were found and 16 studies with a prospective study design could be included in this analysis. RoB 2 (Cochrane Risk of Bias tool in the second Version) in the case of randomized studies and the ROBINS‑I (Risk Of Bias In Nonrandomised Studies of Interventions) for nonrandomized studies were used to assess publication quality. The level of evidence was determined according to AHCPR (Agency for Health Care Policy and Research).
Results
In the case of fractures (AO types A0–A3) without degenerative changes in the bone structure of the thoracic and lumbar spine without indications for operative procedure, conservative treatment with analgesia, physiotherapy and early mobilization is recommended and orthotic treatment is not superior. Surgical treatment, even in cases where conservative treatment was possible, led to improved functionality and pain sensation faster but there were no differences in the long-term results. Assessing the neurological functional deficit, the functional success of the treatment and the kyphosis angle were measured in different ways, reducing the extent of comparability. Although mainly a level of evidence Ib–IIa could be assigned, nearly all included studies had a high risk of bias.
Conclusion
In individual cases treatment with an orthotic device could be a helpful add-on in conservative treatment of fractures in the thoracic and lumbar spine. A treatment with orthotic devices alone cannot be recommended in these cases.
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P.G. Schnadthorst, C. Lankes und C. Schulze geben an, dass kein Interessenkonflikt besteht.
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Carl Neuerburg, München
Ben Ockert, München
Hans Polzer, München
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Supplementary Information
ESM 1:
Darstellung und Beschreibung der in die Auswertung eingeschlossenen Studien
ESM 2:
Darstellung der Veröffentlichungen mit prospektiven und randomisierten Studiendesign inkl. Begründung der Beurteilung und Zitaten (Erweiterung Abb. 2)
ESM 3:
Darstellung der Veröffentlichungen mit prospektiven und nicht-randomisierten Studiendesign inkl. Begründung der Beurteilung und Zitaten (Erweiterung Abb. 3).
ESM 4:
Darstellung der Parameter zur Erfassung des neurologischen Defizites und des funktionellen Outcome
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Schnadthorst, P.G., Lankes, C. & Schulze, C. Orthetische Behandlung traumatisch bedingter Wirbelkörperfrakturen der thorakalen und lumbalen Wirbelsäule. Unfallchirurgie 126, 632–642 (2023). https://doi.org/10.1007/s00113-022-01195-8
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DOI: https://doi.org/10.1007/s00113-022-01195-8