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ORIGINAL
Complicaciones posoperatorias de fracturas toracolumbares en pacientes con traumatismo múltiple según el momento de la cirugía
Early postoperative complications of thoracolumbar fractures in patients with multiple trauma according to the surgical timing
G.A. Ricciardia,
Autor para correspondencia
guillermoricciardi@gmail.com

Autor de correspondencia.
, I.G. Garfinkela, G.G. Carriolia, S. Svarzchteinb, A. Cid Casteulanib, D.O. Ricciardia
a Spine Team, Centro Médico Integral Fitz Roy, Ciudad Autónoma de Buenos Aires, Argentina
b Pelvis and Hip Trauma and Reconstruction Team, Centro Médico Integral Fitz Roy, Ciudad Autónoma de Buenos Aires, Argentina
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Este grupo de pacientes es especialmente vulnerable a las lesiones vertebrales&#44; con una incidencia del 36&#37;&#44; de acuerdo con los registros publicados<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Existe cierto consenso sobre el beneficio de la recuperaci&#243;n neurol&#243;gica de la cirug&#237;a temprana de fracturas toracolumbares con d&#233;ficit neurol&#243;gico asociado&#46; Sin embargo&#44; la cantidad de evidencia sobre el impacto cl&#237;nico de la cirug&#237;a temprana&#44; as&#237; como la tasa de complicaciones en los pacientes con politraumatismos siguen siendo controvertidas&#46; Adem&#225;s&#44; en la literatura disponible existe amplia variabilidad sobre la definici&#243;n de lo que se considera cirug&#237;a &#171;temprana&#187;&#44; que fluct&#250;a entre &#60; 8 y &#60; 72 horas posteriores a la lesi&#243;n<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5&#8211;7</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Tras una revisi&#243;n sist&#233;mica&#44; Bellabarba et al&#46; recomendaron que&#44; de manera ideal&#44; los pacientes con fracturas tor&#225;cicas inestables deber&#237;an someterse a estabilizaci&#243;n temprana &#40;&#60; 72 horas&#41; desde la realizaci&#243;n de lesi&#243;n&#44; para reducir la morbilidad y posiblemente la mortalidad&#46; La literatura sugiere que la intervenci&#243;n quir&#250;rgica temprana deber&#237;a asociarse a un tiempo de hospitalizaci&#243;n m&#225;s breve&#44; menor estancia en la Unidad de Cuidados Intensivos &#40;UCI&#41; y morbilidad&#46; De hecho&#44; los autores proponen la estabilizaci&#243;n temprana en el marco de la &#171;cirug&#237;a de control de da&#241;os&#187; en los pacientes con traumatismos graves<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#8211;11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por contra&#44; otros autores han observado una alta tasa de complicaciones asociadas al &#171;segundo impacto&#187; de la cirug&#237;a de columna&#44; especialmente en las fracturas tor&#225;cicas<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12&#8211;14</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Nuestro objetivo es comparar la tasa de complicaciones en el periodo posoperatorio temprano de las fracturas toracolumbares en los pacientes con traumatismos m&#250;ltiples de alta energ&#237;a&#44; de acuerdo con el tiempo quir&#250;rico&#44; as&#237; como calcular las variables asociadas a la decisi&#243;n del momento quir&#250;rgico en nuestra serie de casos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Realizamos un estudio retrospectivo observacional de pacientes con fracturas toracolumbares causadas por traumatismos de alta energ&#237;a&#44; con lesiones asociadas significativas en otras regiones anat&#243;micas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Dichos pacientes fueron tratados quir&#250;rgicamente en nuestra instituci&#243;n&#44; un centro de referencia para traumatismos ocupacionales&#44; por el mismo equipo quir&#250;rgico y durante el periodo comprendido entre enero de 2013 y diciembre de 2019&#46; Los criterios de inclusi&#243;n fueron&#58; pacientes tratados quir&#250;rgicamente debido a fracturas vertebrales toracolumbares de alta energ&#237;a&#44; con politraumatismos&#46; Definimos a los pacientes con politraumatismos como aquellos con lesiones no vertebrales significativas&#46; Se defini&#243; &#171;significativo&#187; utilizando un valor de la <span class="elsevierStyleItalic">Abbreviated Injury Scale</span> &#40;AIS&#41; superior o igual a tres<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a>&#46; Los criterios de exclusi&#243;n fueron&#58; historias cl&#237;nicas incompletas&#44; tiempo de llegada superior a 72 horas desde el traumatismo&#44; traumatismos penetrantes y pacientes sometidos a procedimientos quir&#250;rgicos percut&#225;neos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Los datos fueron recopilados de las historias cl&#237;nicas e im&#225;genes de nuestra instituci&#243;n&#46; Las im&#225;genes de la columna toracolumbar fueron analizadas y clasificadas por dos autores veteranos&#44; y las puntuaciones cl&#237;nicas fueron evaluadas por m&#233;dicos de cuidados intensivos independientes de nuestro centro&#46; Como variable dependiente registramos el n&#250;mero de complicaciones durante el periodo posoperatorio temprano&#44; definido como los 10 primeros d&#237;as tras la cirug&#237;a&#46; Las complicaciones fueron clasificadas como&#58; &#171;complicaciones cl&#237;nicas&#187; &#40;muerte&#44; bacteriemia&#44; neumon&#237;a&#44; s&#237;ndrome de distr&#233;s respiratorio agudo &#91;SDRA&#93;&#44; fallo multiorg&#225;nico&#44; infecciones nosocomiales y <span class="elsevierStyleItalic">shock</span> s&#233;ptico&#41;&#44; &#171;complicaciones quir&#250;gicas&#187; &#40;intraoperatorias&#44; asociadas a la evoluci&#243;n de la herida&#44; la fractura y el implante&#41; y &#171;otras complicaciones&#187; &#40;agrupando aquellas asociadas a hospitalizaciones prolongadas y comorbilidades traum&#225;ticas&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; medimos como variable del resultado secundario lo siguiente&#58; situaci&#243;n neurol&#243;gica posoperatoria&#44; de acuerdo con la escala de la <span class="elsevierStyleItalic">American Spinal Cord Association</span> &#40;ASIA&#41; durante el &#250;ltimo seguimiento disponible<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a>&#44; duraci&#243;n de la estancia en la UCI y situaci&#243;n fisiol&#243;gica tras la cirug&#237;a&#44; calculada mediante la escala SOFA &#40;<span class="elsevierStyleItalic">Sequential Organ Failure Assessment</span>&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a>&#46; Dicha escala es un sistema de puntuaci&#243;n utilizado en los pacientes ingresados en la UCI&#44; a fin de determinar el nivel de disfunci&#243;n org&#225;nica y el riesgo de mortalidad&#46; Incluye las variables PaO<span class="elsevierStyleInf">2</span>&#47;FiO<span class="elsevierStyleInf">2</span>&#44; n&#250;mero de plaquetas&#44; escala Glasgow&#44; bilirrubina&#44; presi&#243;n arterial media y creatinina&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables independientes principales fueron la demora quir&#250;rgica&#44; definida como el periodo de tiempo transcurrido entre la lesi&#243;n y la cirug&#237;a de columna &#40;h&#41;&#46; Otras variables independientes registradas fueron edad&#44; sexo&#44; tipo de traumatismo&#44; comorbilidades previas&#44; v&#233;rtebras toracolumbares fracturadas&#44; regi&#243;n vertebral &#40;tor&#225;cica o lumbar&#41;&#44; tipo de lesi&#243;n conforme al Sistema de Clasificaci&#243;n de Lesiones Toracolumbares AO &#40;AOSTLICS&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a>&#44; ASIA al ingreso&#44; <span class="elsevierStyleItalic">Injury Severity Score</span> &#40;ISS&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a>&#44; lesiones significativas en otras regiones anat&#243;micas &#40;&#171;cabeza&#187;&#44; &#171;cuello y columna cervical&#187;&#44; &#171;cara&#187;&#44; &#171;t&#243;rax y columna tor&#225;cica&#187;&#44; &#171;abdomen y columna lumbar&#187;&#44; &#171;pelvis y extremidades&#187; y &#171;exterior o piel&#187;&#41;&#44; definidas de acuerdo con la escala AIS y con valor superior o igual a tres<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a>&#44; cirug&#237;a de control de da&#241;os previa&#44; otras cirug&#237;as mayores&#44; situaci&#243;n fisiol&#243;gica al ingreso con arreglo a SOFA&#44; criterios de politraumatismos conforme a la definici&#243;n de Berl&#237;n &#40;&#171;dos o m&#225;s lesiones significativas y presencia de una o m&#225;s de las condiciones patol&#243;gicas siguientes&#58; hipotensi&#243;n arterial inferior a 90 mmHg&#44; escala Glasgow inferior a 8&#44; exceso de base a &#8722;6&#44; tiempo de tromboplastina parcial o PTT superior o igual a 40 s&#44; ratio normalizado internacional o INR superior o igual a 1&#44;4&#44; edad superior o igual a 70 a&#241;os&#187;&#41;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">3</span></a>&#44; &#225;cido l&#225;ctico arterial al ingreso e intercurrencias previas a la cirug&#237;a de columna&#44; tipo de cirug&#237;a y niveles de fusi&#243;n&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los autores realizaron una comparaci&#243;n entre dos grupos&#44; sobre la base de la demora quir&#250;rgica inferior o superior a 72 horas &#40;cirug&#237;a temprana o tard&#237;a&#44; respectivamente&#41;&#46; Decidimos utilizar este punto de corte temporal bas&#225;ndonos en el intervalo de tiempo m&#225;s utilizado en estudios previos&#44; de acuerdo con nuestra revisi&#243;n bibliogr&#225;fica<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#44;10&#44;12</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En nuestro centro&#44; la toma de decisiones sobre el momento de la cirug&#237;a para fracturas toracolumbares inestables se realiz&#243; a trav&#233;s de una labor interdisciplinar guiada por los m&#233;dicos de la UCI&#47;Urgencias&#44; que son los responsables del manejo inicial y la reanimaci&#243;n&#46; Este proceso incluy&#243; la participaci&#243;n de nuestro equipo de columna y otros especialistas&#44; de acuerdo con las lesiones asociadas &#40;pelvis y cadera&#44; extremidades inferiores&#44; extremidades superiores&#44; cirug&#237;a pl&#225;stica&#44; cirug&#237;a general&#44; cirug&#237;a vascular&#44; neurocirug&#237;a&#41;&#46; Se priorizaron la situaci&#243;n cl&#237;nica y neurol&#243;gica al ingreso y el tratamiento de las lesiones potencialmente mortales &#40;cirug&#237;a de control de da&#241;os&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La aprobaci&#243;n &#233;tica fue garantizada por el Comit&#233; de &#201;tica de Investigaci&#243;n de nuestra instituci&#243;n&#44; obteni&#233;ndose el consentimiento informado para la publicaci&#243;n de la informaci&#243;n e im&#225;genes de los pacientes o de un representante legalmente autorizado&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">An&#225;lisis estad&#237;stico&#58;</span> las variables categ&#243;ricas se expresaron como n&#250;mero y porcentaje&#44; y se analizaron mediante la prueba &#967;<span class="elsevierStyleSup">2</span> o la prueba de Fisher&#46; Las variables de intervalo se describieron como media y mediana&#44; de acuerdo con el tipo de distribuci&#243;n y la medida de dispersi&#243;n&#58; desviaci&#243;n est&#225;ndar &#40;DE&#41; o rango intercuart&#237;lico &#40;RIC&#41; 25-75&#46; Se realiz&#243; la prueba de normalidad de Shapiro-Wilk para calcular el tipo de distribuci&#243;n de las variables cuantitativas&#46; Para la comparaci&#243;n de las variables continuas&#44; se realizaron la prueba <span class="elsevierStyleItalic">t</span> de Student o <span class="elsevierStyleItalic">U</span> de Mann-Whitney&#44; de acuerdo con la distribuci&#243;n expresada&#46; Se realiz&#243; la prueba de correlaci&#243;n de Pearson para analizar las variables continuas&#46; Los valores p &#60; 0&#44;05 se consideraron estad&#237;sticamente significativos&#46; Se utiliz&#243; el <span class="elsevierStyleItalic">software</span> SPSS Statics 25 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#44; EE&#46; UU&#46;&#41; para realizar el an&#225;lisis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0070" class="elsevierStylePara elsevierViewall">Revisamos 104 pacientes tratados quir&#250;rgicamente de fracturas toracolumbares con traumatismos de alta energ&#237;a durante el periodo temporal de estudio&#46; Incluimos 54 pacientes con lesiones significativas asociadas en otras regiones anat&#243;micas&#44; excluy&#233;ndose 14 pacientes de acuerdo con los criterios de exclusi&#243;n &#40;lesiones penetrantes&#58; tres casos&#59; tiempo de llegada superior a 72 horas desde el traumatismo&#58; 11 casos&#41;&#44; por lo que nuestra muestra se compuso de 40 pacientes &#40;39 varones y una mujer&#41;&#46; Los tipos de traumatismo fueron&#58; 22 accidentes de tr&#225;fico &#40;55&#37;&#41;&#44; 16 ca&#237;das desde lo alto &#40;40&#37;&#41;&#44; un accidente de equitaci&#243;n &#40;2&#44;5&#37;&#41; y una electrocuci&#243;n con ca&#237;da desde lo alto &#40;2&#44;5&#37;&#41;&#46; Todos los pacientes fueron tratados utilizando abordaje posterior convencional&#44; siendo los procedimientos quir&#250;rgicos los siguientes&#58; 11 artrodesis &#40;27&#44;5&#37;&#41;&#44; seis descompresiones y artrodesis &#40;15&#37;&#41;&#44; 11 reducciones&#44; descompresiones y artrodesis &#40;27&#44;5&#37;&#41;&#44; 10 reducciones&#44; descompresiones&#44; duraplastias y artrodesis &#40;25&#37;&#41;&#44; dos descompresiones&#44; duraplastias y artrodesis &#40;5&#37;&#41;&#46; Los niveles medios de fijaci&#243;n fueron 5 &#40;RIC &#61; 5-6&#41;&#46; La descripci&#243;n de la muestra se resume en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Los resultados de la comparaci&#243;n de los dos grupos de pacientes&#44; de acuerdo con las horas transcurridas entre la lesi&#243;n y la cirug&#237;a &#40;antes o despu&#233;s de 72 horas&#41; se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Complicaciones posoperatorias tempranas</span><p id="par0080" class="elsevierStylePara elsevierViewall">El n&#250;mero medio de complicaciones fue inferior en los pacientes operados tempranamente &#40;mediana &#61; 0&#44;5&#47;RIC &#61; 0-1&#44;5&#41; en comparaci&#243;n con los tratados quir&#250;rgicamente antes de 72 horas &#40;mediana 1&#47;RIC &#61; 0-3&#41;&#46; Sin embargo&#44; esta asocaci&#243;n no fue estad&#237;sticamente significativa &#40;p &#61; 0&#44;827 &#91;total&#93;&#59; p &#61; 0&#44;610 &#91;cl&#237;nicas&#93;&#59; p &#61; 0&#44;299 &#91;quir&#250;rgicas&#93;&#59; p &#61; 0&#44;343 &#91;otros&#93;&#41;&#46; Las complicaciones registradas fueron&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Complicaciones cl&#237;nicas &#40;n &#61; 26&#41;&#58; 10 infecciones del tracto urinario &#40;25&#37;&#41;&#44; cuatro sepsis &#40;10&#37;&#41;&#44; tres neumon&#237;as &#40;7&#44;5&#37;&#41;&#44; tres s&#237;ndromes febriles sin foco &#40;7&#44;5&#37;&#41;&#44; dos atelectasias &#40;5&#37;&#41;&#44; un SDRA &#40;2&#44;5&#37;&#41;&#44; un <span class="elsevierStyleItalic">shock</span> s&#233;ptico &#40;2&#44;5&#37;&#41;&#44; un <span class="elsevierStyleItalic">shock</span> neurog&#233;nico &#40;2&#44;5&#37;&#41;&#44; una trombosis venosa profunda &#40;2&#44;5&#37;&#41;&#44; una insuficiencia hep&#225;tica &#40;2&#44;5&#37;&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Complicaciones quir&#250;gicas &#40;n &#61; 7&#41;&#58; cinco infecciones del sitio quir&#250;rgico &#40;12&#44;5&#37;&#41;&#44; un hematoma &#40;2&#44;5&#37;&#41;&#44; una dehiscencia de la lesi&#243;n &#40;2&#44;5&#37;&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Otras complicaciones &#40;n &#61; 11&#41;&#58; cinco &#250;lceras por dec&#250;bito 5 &#40;12&#44;5&#37;&#41;&#44; cuatro empiemas &#40;10&#37;&#41;&#44; una hiponatremia sintom&#225;tica &#40;2&#44;5&#37;&#41;&#44; una infecci&#243;n del sitio quir&#250;rgico de cirug&#237;a no vertebral &#40;2&#44;5&#37;&#41;&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Situaci&#243;n fisiol&#243;gica tras la cirug&#237;a</span><p id="par0100" class="elsevierStylePara elsevierViewall">La puntuaci&#243;n SOFA posoperatoria media fue m&#225;s alta en el grupo de pacientes operados antes de 72 horas desde el traumatismo &#40;1&#47;RIC &#61; 0-2&#44;5&#41; en comparaci&#243;n con aquellos tratados tras 72 horas &#40;0&#44;5&#47;RIC &#61; 0-2&#41;&#44; pero la asociaci&#243;n no fue significativa &#40;p &#61; 0&#44;457&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Recuperaci&#243;n neurol&#243;gica</span><p id="par0105" class="elsevierStylePara elsevierViewall">Al ingreso&#44; 24 pacientes &#40;60&#37;&#41; tuvieron s&#237;ntomas neurol&#243;gicos asociados&#46; Dentro de este grupo&#44; 22 &#40;92&#37;&#41; tuvieron lesiones neurol&#243;gicas graves &#40;20 ASIA A y dos ASIA B&#41;&#46; Se obtuvo mejora posoperatoria de uno o m&#225;s grados de ASIA en siete pacientes &#40;29&#37;&#41;&#46; La recuperaci&#243;n neurol&#243;gica fue m&#225;s frecuente en los pacientes operados antes de 72 horas&#44; pero esta asociaci&#243;n no fue estad&#237;sticamente significativa &#40;p &#61; 0&#44;659&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Variables asociadas al tiempo quir&#250;rgico &#40;antes o despu&#233;s de 72 horas&#41; en nuestra serie de casos</span><p id="par0110" class="elsevierStylePara elsevierViewall">La cirug&#237;a temprana no estuvo significativamente asociada a un menor rango medio de edad &#40;p &#61; 0&#44;014&#41;&#44; menor puntuaci&#243;n SOFA al ingreso &#40;p &#61; 0&#44;029&#41;&#44; valores de presi&#243;n sist&#243;lica mayores &#40;p &#61; 0&#44;032&#41; ni presencia de d&#233;ficit neurol&#243;gico preoperatorio &#40;p &#61; 0&#44;012&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">La cirug&#237;a de control de da&#241;os previa &#40;laparotom&#237;a o fijaci&#243;n externa de la pelvis&#41; y otras cirug&#237;as mayores estuvieron significativamente asociadas a la cirug&#237;a de columna transcurridas 72 horas &#40;p &#61; 0&#44;019 y p &#61; 0&#44;007&#44; respectivamente&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Las principales lesiones significativas no vertebrales de nuestra muestra fueron&#58; 32 traumatismos tor&#225;cicos cerrados &#40;80&#37;&#41;&#44; 20 traumatismos craneales graves &#40;50&#37;&#41;&#44; 11 traumatismos abdominales cerrados &#40;27&#44;5&#37;&#41; y siete traumatismos p&#233;lvicos &#40;17&#44;5&#37;&#41;&#46; La asociaci&#243;n entre estas lesiones y el momento quir&#250;rgico no fue estad&#237;sticamente significativa&#46; Sin embargo&#44; podemos destacar que todos los pacientes que padecieron fracturas p&#233;lvicas fueron intervenidos transcurridas 72 horas&#44; y que el valor p se aproxim&#243; a 0&#44;05 &#40;p &#61; 0&#44;08&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">figs&#46; 2</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">La demora quir&#250;rgica tras el traumatismo reflej&#243; una correlaci&#243;n estad&#237;sticamente significativa con la magnitud de la puntuaci&#243;n SOFA &#40;p &#61; 0&#44;007&#47;coeficiente de correlaci&#243;n de Pearson &#61; 0&#44;422&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">Diversos autores calcularon que la cirug&#237;a temprana podr&#237;a estar asociada a una menor estancia hospitalaria&#44; menor estancia en la UCI&#44; menor duraci&#243;n de la ventilaci&#243;n mec&#225;nica&#44; y menor morbilidad respiratoria<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#8211;10</span></a>&#46; Sin embargo&#44; la evidencia que respalda esta conclusi&#243;n en Iberoam&#233;rica es a&#250;n escasa&#46; Por otro lado&#44; se describi&#243; una mayor mortalidad en pacientes con fracturas toracolumbares inestables operados antes de las 72 horas en un estudio prospectivo<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a>&#46; Nosotros reportamos menores tasas de complicaci&#243;n y d&#237;as de estancia en UCI en los pacientes tratados quir&#250;rgicamente antes de las 72 horas&#44; aunque estos hallazgos no fueron estad&#237;sticamente significativos en nuestro estudio&#46; No se reportaron fallecimientos en nuestra muestra durante el seguimiento&#46; Adem&#225;s&#44; la cirug&#237;a temprana no asoci&#243; diferencias en la puntuaci&#243;n SOFA sobre ingreso en UCI posoperatorio&#44; en comparaci&#243;n con la cirug&#237;a tard&#237;a&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Entre las complicaciones cl&#237;nicas de nuestra serie&#44; las complicaciones respiratorias agrupadas &#40;neumon&#237;a&#44; atelectasia&#44; SDRA&#41; fueron las m&#225;s frecuentes&#44; tras las infecciones urinarias&#46; Las complicaciones respiratorias fueron independientes del momento de la cirug&#237;a<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">20&#8211;22</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">El proceso de toma de decisiones sobre el momento quir&#250;rgico en los pacientes traumatol&#243;gicos implica una evaluaci&#243;n multidisciplinar para acordar los criterios cl&#237;nicos y quir&#250;rgicos&#44; pudiendo ser un proceso dif&#237;cil de lograr&#46; El an&#225;lisis retrospectivo de nuestra serie reflej&#243; que ambos grupos no presentan diferencias en relaci&#243;n con la gravedad del traumatismo&#44; aunque&#44; sin embargo&#44; los pacientes del grupo de cirug&#237;a temprana eran considerablemente m&#225;s j&#243;venes&#44; con situaciones hemodin&#225;micas m&#225;s estables y menor compromiso fisiol&#243;gico con arreglo a la puntuaci&#243;n SOFA&#44; y con compromiso neurol&#243;gico m&#225;s frecuentemente asociado&#46; Adem&#225;s&#44; la demora quir&#250;rgica guard&#243; una correlaci&#243;n positiva con la magnitud de la puntuaci&#243;n SOFA al ingreso&#44; lo cual sugiere que el proceso de &#171;toma de decisiones&#187; en nuestra muestra estuvo m&#225;s asociado a la evaluaci&#243;n fisiol&#243;gica que a la estrictamente anat&#243;mica&#46; Los autores sugieren la necesidad de investigaci&#243;n futura para calcular si la puntuaci&#243;n SOFA podr&#237;a ser un factor pron&#243;stico decisivo de la cirug&#237;a de columna en los pacientes traumatol&#243;gicos&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Otras variables significativamente asociadas a la demora quir&#250;rgica en nuestra serie fueron la necesidad de la cirug&#237;a de control de da&#241;os &#40;laparotom&#237;a&#44; fijaci&#243;n p&#233;lvica&#41; u otras intervenciones quir&#250;rgicas mayores para priorizar el tratamiento de las lesiones potencialmente letales tales como los traumatismos p&#233;lvicos inestables&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La recuperaci&#243;n neurol&#243;gica&#44; medida como resultado secundario&#44; no reflej&#243; diferencias entre los grupos aunque&#44; sin embargo&#44; creemos que esto guard&#243; relaci&#243;n con el peque&#241;o tama&#241;o de la muestra y la predominancia del da&#241;o neurol&#243;gico grave al ingreso &#40;22 &#171;ASIA A&#187; y dos &#171;ASIA B&#187;&#41;&#46; Con independencia de la demora quir&#250;rgica&#44; el 29&#37; de los casos &#40;siete de 24 pacientes&#41; mejor&#243; su situaci&#243;n neurol&#243;gica en uno o m&#225;s grados de la escala ASIA tras la cirug&#237;a&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Como este documento incluy&#243; solo pacientes operados utilizando un abordaje convencional posterior&#44; deber&#225;n considerarse los beneficios de la cirug&#237;a m&#237;nimente invasiva en las investigaciones futuras<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Un punto d&#233;bil de nuestro estudio fue su car&#225;cter retrospectivo&#44; con un posible sesgo de registro y la inclusi&#243;n de una peque&#241;a muestra&#46; Creemos que es necesario seguir desarrollando investigaci&#243;n futura con un nivel m&#225;s elevado de evidencia&#46; De otro modo consideramos que nuestro documento a&#241;ade informaci&#243;n sobre el beneficio de la cirug&#237;a temprana en un centro de Iberoam&#233;rica&#44; lo cual coincide con lo reportado en otras regiones del mundo&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusi&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">La cirug&#237;a temprana para fracturas toracolumbares inestables fue una estrategia terap&#233;utica segura en un centro traumatol&#243;gico iberomericano&#46; La tasa de complicaciones posoperatorias tempranas no reflej&#243; diferencias significativas entre los grupos de cirug&#237;a temprana y tard&#237;a &#40;antes y despu&#233;s de 72 horas&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Los pacientes quir&#250;rgicamente tratados antes de las 72 horas posteriores al traumatismo fueron m&#225;s j&#243;venes y presentaron valores de presi&#243;n arterial m&#225;s elevados&#44; menor da&#241;o fisiol&#243;gico y padecieron da&#241;o neurol&#243;gico con mayor frecuencia&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La demora quir&#250;rgica guard&#243; una correlaci&#243;n positiva con la puntuaci&#243;n SOFA al ingreso&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Nivel de evidencia</span><p id="par0180" class="elsevierStylePara elsevierViewall">Nivel de evidencia IV&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Financiaci&#243;n</span><p id="par0185" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Complicaciones posoperatorias tempranas"
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              "titulo" => "Situaci&#243;n fisiol&#243;gica tras la cirug&#237;a"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo es comparar la tasa de complicaciones acontecidas durante el posoperatorio temprano de fracturas toracolumbares en pacientes con traumatismos m&#250;ltiples de alta energ&#237;a seg&#250;n el momento de la cirug&#237;a&#46; Como objetivo secundario&#44; estimar qu&#233; variables se asociaron el desarrollo de la cirug&#237;a antes de las 72 horas&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis retrospectivo de una serie de pacientes con fracturas toracolumbares y m&#250;ltiples lesiones asociadas en otras regiones anat&#243;micas por traumatismo de alta energ&#237;a&#46; Tratados quir&#250;rgicamente en un centro de derivaci&#243;n de trauma laboral&#44; por el mismo equipo quir&#250;rgico y durante el periodo comprendido entre enero de 2013 y diciembre de 2019&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 40 pacientes &#40;39 hombres y una mujer&#41;&#46; La tasa de complicaciones tempranas fue independiente del momento de la cirug&#237;a &#40;antes o despu&#233;s de las 72 horas&#41; &#40;p &#61; 0&#44;827&#41;&#46; Se presentaron diferencias estad&#237;sticamente significativas entre ambos grupos en las variables edad&#44; presi&#243;n arterial sist&#243;lica&#44; puntuaci&#243;n SOFA inicial y presencia de da&#241;o neurol&#243;gico &#40;p &#61; 0&#44;014&#59; p &#61; 0&#44;029&#59; p &#61; 0&#44;032&#59; p &#61; 0&#44;012&#41;&#46; La demora quir&#250;rgica global se correlacion&#243; con el puntuaci&#243;n SOFA al ingreso &#40;p &#61; 0&#44;007&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La tasa de complicaciones en el posoperatorio temprano de fracturas toracolumbares no mostr&#243; diferencias significativas entre los grupos de cirug&#237;a temprana y tard&#237;a&#46; Los pacientes operados antes de las 72 horas del trauma fueron m&#225;s j&#243;venes&#44; presentaron valores m&#225;s elevados de presi&#243;n arterial&#44; menor da&#241;o fisiol&#243;gico y asociaron s&#237;ntomas neurol&#243;gicos con mayor frecuencia&#46; La demora quir&#250;rgica se correlacion&#243; positivamente con la puntuaci&#243;n SOFA al ingreso&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Our objective was to compare the rate of complications in thoracolumbar fractures that occurred during the early postoperative period in patients with multiple high-energy trauma according to the time of surgery&#46; As a secondary objective&#44; to estimate which variables were associated with surgery before 72 h&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of a series of patients with thoracolumbar fractures and multiple associated injuries in other anatomical regions due to high energy trauma&#46; Surgically treated in an occupational trauma referral center&#44; by the same surgical team and during the period between January 2013 and December 2019&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">We analyzed a sample of 40 patients &#40;39 men and 1 woman&#41;&#46; The rate of complications was independent of surgical delay &#40;before and after 72 h&#41; &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;827&#41;&#46; There were statistically significant differences between early and later surgery groups in the variables age&#44; systolic blood pressure&#44; initial SOFA score and presence of neurological damage &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;014&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;029&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;032&#59; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;012&#41;&#46; The overall surgical delay was correlated with the SOFA score &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;007&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The rate of early postoperative complications did not show significant differences between the early and late surgery groups&#46; We observed that the patients who had been operated before 72 h from trauma were younger&#44; had more association with neurological syntoms&#44; presented higher blood pressure values and less physiological damage&#46; Surgical delay was positively correlated with SOFA score on arrival&#46;</p></span>"
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                  \t\t\t\t">36 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Varones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;97&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tipo de traumatismo&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Accidentes de tr&#225;fico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">22 &#40;55&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ca&#237;da desde altura&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Accidente de equitaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Electrocuci&#243;n con ca&#237;da desde altura&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausencia de comorbilidades&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">32 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60; 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Regi&#243;n vertebral&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tor&#225;cica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27 &#40;67&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lumbar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;32&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">AOSTICS &#40;Tipo&#41;&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">9 &#40;22&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;12&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ASIA al ingreso&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>E&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">16 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Fracturas vertebrales m&#250;ltiples&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">20 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ISS&#47;media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lesi&#243;n en la cabeza &#40;AIS &#62; 3&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">20 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lesi&#243;n en la cara &#40;AIS &#62; 3&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lesi&#243;n en el cuello &#40;AIS &#62; 3&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lesi&#243;n tor&#225;cica &#40;AIS &#62; 3&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">32 &#40;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Lesi&#243;n abdominal &#40;AIS &#62; 3&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11 &#40;27&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lesi&#243;n p&#233;lvica &#40;AIS &#62; 3&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">7 &#40;17&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Lesi&#243;n cut&#225;nea &#40;AIS &#62; 3&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;271&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Columna lumbar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">AOSTICS&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tipo A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tipo B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tipo C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;484&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASIA E&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ASIA A&#47;B&#47;C&#47;D&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">13 &#40;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Fracturas vertebrales m&#250;ltiples&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Escala</span><span class="elsevierStyleItalic">Glasgow al ingreso&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">0&#44;457&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mejor&#237;a &#40;uno o m&#225;s grados ASIA&#41;&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 18884415
Idioma original: Español
DOI:10.1016/j.recot.2022.07.007
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