IMPORTANCE OF RADIOGRAPHY IN ORTHOSTATISM IN THE CONDUCT OF THORACOLOMBAR TRANSITION FRACTURES

ABSTRACT Objective: To evaluate the importance of radiography in the orthostatic position in the initial assessment of patients with thoracolumbar transition fractures and whether this image changes the surgical indication. Methods: Medical records and imaging tests of patients treated for thoracolumbar transition fractures from June 2018 to June 2019 were evaluated. Trauma patients between 18 and 60 years of age with fractures of T10 to L3 who had been indicated for conservative treatment were included. Cases of fractures considered unstable were excluded. Radiographs were taken with the patient in the supine position (supine X-ray), computed tomography (CT), and orthostatic radiography (orthostatic X-ray). Segmental kyphosis and degree of wedging were evaluated. The measurements were compared using the Wilcoxon test. The McNemar test was used to assess changes in conduct according to the criteria for surgical indication (kyphosis ≥ 25 ° and wedging ≥ 50%). Results: Fifty patients were evaluated, nine of whom (18%) were indicated for a change of conduct according to the orthostatic examinations and were submitted to surgical treatment. Vertebral kyphosis increased by 40.6% (p <0.001). The wedging increased by 25.62% (p <0.0001). Conclusion: Eighteen percent of the total number of patients who did not present instability criteria in radiographs in the supine position satisfied at least one of these criteria when the orthostatic X-ray was performed. Level of evidence 3B; Retrospective case series study.摘要 目的：评估立位X线摄影在胸腰椎移行骨折患者初始评估中的价值，以及该影像学检查是否会调整手术治疗指征。方法：回顾性分析2018年6月至2019年6月收治的胸腰椎移行骨折患者的病历及影像学资料。纳入年龄18~60岁、骨折节段为T10至L3且初始拟定保守治疗方案的创伤患者，排除存在不稳定性骨折的病例。所有患者均行仰卧位X线摄影（supine X-ray）、计算机断层扫描（computed tomography, CT）及立位X线摄影（orthostatic X-ray）检查。评估节段后凸角与椎体楔变程度，采用Wilcoxon检验比较测量结果，采用McNemar检验评估依据手术指征（后凸角≥25°且楔变≥50%）制定的诊疗方案变化情况。结果：共纳入50例患者，其中9例（18%）根据立位影像学检查结果变更诊疗方案并接受手术治疗。患者椎体后凸角平均升高40.6%（p<0.001），椎体楔变程度平均增加25.62%（p<0.0001）。结论：初始仰卧位X线摄影未检出不稳定性骨折指征的患者中，有18%在接受立位X线摄影后满足至少一项手术指征。证据等级：3B级；回顾性病例系列研究。