Pain regulation and health-related quality of life after thoracolumbar fractures of the spine
Pain regulation and health-related quality of life after thoracolumbar fractures of the spine
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DOI：
10.1007/s00586-007-0395-x
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发表时间：
2007-11-01
影响因子：
2.8
通讯作者：
Rueger, Johannes M.
中科院分区：
文献类型：
--
作者：
Briem, Daniel;Behechtnejad, Aryan;Rueger, Johannes M.
胸腰段脊柱骨折是人类骨骼最严重的损伤之一。特别是在年轻患者中，它们通常由高能量事故引起。最近，可以观察到范式向更积极的治疗策略（包括前路手术）的转变。然而，到目前为止，只有很少的数据存在反映生活质量（QoL）后，这样的伤害。本研究的目的是评估中期生活质量，并进一步确定影响胸腰椎骨折患者临床结局的因素。回顾性评价了在我们机构10年期间接受治疗的906例患者的数据。只有年龄在18 - 65岁之间的单节段创伤性损伤患者没有神经功能缺损，其他部位的伴随损伤和内部合并症被纳入研究（n = 204）。将三个不同的治疗组（即非手术、背侧和背腹侧稳定）与健康对照以及不同的疼痛人群进行比较。使用既定问卷（SF-36、HFAQ、VAS-Spinescore、PRQ和PTSD）评估QoL。65%的入选患者（n = 133）在受伤后平均随访5.3 +/- 1.7年时接受了研究。所有治疗组显示出相同的性别和年龄分布。在手术组中发现了更严重和不稳定的损伤，这些损伤与更高的治疗费用和更长的无法工作时间有关。与健康对照组相比，所有组的生活质量受损程度相同。此外，在这项研究中接受治疗的所有患者在生活质量和疼痛调节参数方面都明显优于腰痛患者。在我们的研究中，与健康对照组相比，胸腰椎骨折患者的生活质量降低。因此，患者似乎没有恢复其以前的QoL。然而，所有组的不适程度都很低，即使是那些需要大范围手术的更严重损伤的患者。总的来说，胸腰椎创伤性骨折后的结局和生活质量似乎是由损伤的严重程度决定的，而不是由疼痛调节或其他心理社会因素决定的，这可能是下背痛疾病的情况。
Fractures of the thoracolumbar spine rank among the severest injuries of the human skeleton. Especially in younger patients they often result from high-energy accidents. Recently, a shift in paradigm towards more aggressive treatment strategies including anterior procedures could be observed. However, so far only few data exist reflecting the quality of life (QoL) after such injuries. The aim of this study was to evaluate medium-term QoL and further to identify factors that influence the clinical outcome in patients with fractures of the thoracolumbar spine. Data of 906 patients who were treated during a 10-year period in our institution were evaluated retrospectively. Only patients with single-level traumatic injuries aged between 18 and 65 years without neurological deficits, concomitant injuries of other locations and internal comorbidities were included into the investigation (n = 204). Three different treatment groups (i.e. non-operative, dorsal and dorsoventral stabilisation) were compared to healthy controls as well as different pain populations. The QoL was assessed using established questionnaires (SF-36, HFAQ, VAS-Spinescore, PRQ, and PTSD). Sixty-five percent of the included patients (n = 133) were studied at an average follow-up of 5.3 +/- 1.7 years after injury. All treatment groups revealed an identical gender and age distribution. More severe and unstable injuries were found in the surgical groups associated with higher treatment costs and a longer inability to work. Compared to healthy controls, QoL was compromised to the same extent in all groups. Furthermore, all patients treated in this study did significantly better than low back pain individuals with regard to QoL and pain regulation parameters. In our study, patients with thoracolumbar spine fractures showed a reduced QoL compared to healthy controls. Thus, patients do not seem to regain their former QoL. However, the level of discomfort was comparably low in all groups, even in patients with more severe injuries requiring extensive surgery. Overall, outcome and QoL after traumatic fractures of the thoracolumbar spine rather seem to be determined by the severity of injury than by pain regulation or other psychosocial factors which is likely the case in low back pain disorders.