中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2011年
2期
152-156
,共5页
杨帆%宋先舟%白祥军%周锡渊%张剑%曹园
楊帆%宋先舟%白祥軍%週錫淵%張劍%曹園
양범%송선주%백상군%주석연%장검%조완
多处创伤%脊柱损伤
多處創傷%脊柱損傷
다처창상%척주손상
Multiple trauma%Spinal injuries
目的 探讨多发伤患者合并脊柱脊髓损伤的临床特点.方法 回顾性分析2004年3月-2009年3月收治的143例合并脊柱脊髓损伤的多发伤患者,统计致伤原因、脊柱损伤节段、合并伤、并发症、治疗方式和转归.结果 高处坠落伤和交通伤是主要致伤原因,分别为77例(53.8%)和55例(38.5%),损伤节段依次为腰椎101处(50.8%)、胸椎61处(30.7%)、颈椎29处(14.6%)及骶尾椎8处(4.0%);合并伤依次为胸部163处(38.6%)、腹部84处(19.9%)、头颈部77处(18.3%)、四肢65处(15.4%)、面部17处(4.0%)和体表16处(3.8%).早期并发症依次为电解质紊乱33例(16.8%)、呼吸系统感染30例(15.3%)和腹胀19例(9.7%);晚期并发症依次为营养不良26例(13.3%)、肌萎缩23例(11.7%)和深静脉血栓11例(5.6%).治疗方式依次为手术治疗106例(74.1%),保守治疗37例(25.9%).治疗前美国脊柱损伤协会(ASIA)评级E级20例(14.0%),治疗后E级53例(37.1%).死亡12例,病死率为8.4%,主要死亡原因为MOF、脑疝、营养衰竭等.随着ASIA残损分级的提高,各组并发症和病死率也显著增加(P＜0.05).结论 高能量损伤是多发伤合并脊柱脊髓损伤的主要致伤因素,患者病情重,合并伤复杂,并发症多,治疗棘手,病死率高.
目的 探討多髮傷患者閤併脊柱脊髓損傷的臨床特點.方法 迴顧性分析2004年3月-2009年3月收治的143例閤併脊柱脊髓損傷的多髮傷患者,統計緻傷原因、脊柱損傷節段、閤併傷、併髮癥、治療方式和轉歸.結果 高處墜落傷和交通傷是主要緻傷原因,分彆為77例(53.8%)和55例(38.5%),損傷節段依次為腰椎101處(50.8%)、胸椎61處(30.7%)、頸椎29處(14.6%)及骶尾椎8處(4.0%);閤併傷依次為胸部163處(38.6%)、腹部84處(19.9%)、頭頸部77處(18.3%)、四肢65處(15.4%)、麵部17處(4.0%)和體錶16處(3.8%).早期併髮癥依次為電解質紊亂33例(16.8%)、呼吸繫統感染30例(15.3%)和腹脹19例(9.7%);晚期併髮癥依次為營養不良26例(13.3%)、肌萎縮23例(11.7%)和深靜脈血栓11例(5.6%).治療方式依次為手術治療106例(74.1%),保守治療37例(25.9%).治療前美國脊柱損傷協會(ASIA)評級E級20例(14.0%),治療後E級53例(37.1%).死亡12例,病死率為8.4%,主要死亡原因為MOF、腦疝、營養衰竭等.隨著ASIA殘損分級的提高,各組併髮癥和病死率也顯著增加(P＜0.05).結論 高能量損傷是多髮傷閤併脊柱脊髓損傷的主要緻傷因素,患者病情重,閤併傷複雜,併髮癥多,治療棘手,病死率高.
목적 탐토다발상환자합병척주척수손상적림상특점.방법 회고성분석2004년3월-2009년3월수치적143례합병척주척수손상적다발상환자,통계치상원인、척주손상절단、합병상、병발증、치료방식화전귀.결과 고처추락상화교통상시주요치상원인,분별위77례(53.8%)화55례(38.5%),손상절단의차위요추101처(50.8%)、흉추61처(30.7%)、경추29처(14.6%)급저미추8처(4.0%);합병상의차위흉부163처(38.6%)、복부84처(19.9%)、두경부77처(18.3%)、사지65처(15.4%)、면부17처(4.0%)화체표16처(3.8%).조기병발증의차위전해질문란33례(16.8%)、호흡계통감염30례(15.3%)화복창19례(9.7%);만기병발증의차위영양불량26례(13.3%)、기위축23례(11.7%)화심정맥혈전11례(5.6%).치료방식의차위수술치료106례(74.1%),보수치료37례(25.9%).치료전미국척주손상협회(ASIA)평급E급20례(14.0%),치료후E급53례(37.1%).사망12례,병사솔위8.4%,주요사망원인위MOF、뇌산、영양쇠갈등.수착ASIA잔손분급적제고,각조병발증화병사솔야현저증가(P＜0.05).결론 고능량손상시다발상합병척주척수손상적주요치상인소,환자병정중,합병상복잡,병발증다,치료극수,병사솔고.
Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in 143 multiple trauma patients combined with spine and spinal cord injuries admitted to our department between March 2004 and March 2009.The parameters including injury cause,segment of injuries,associated injuries,complications,treatment methods and outcomes were analyzed.Results Falling and traffic accidents were the main causes for the injuries of spine and spinal cord,accounting for 53.8%(77 cases)and 38.5%(55 cases),respectively.The injured segments involved 101 lumbar vertebrae(50.8%),61 thoracic vertebrae(30.7%),29 cervical spines(14.6%)and 8 sacrococcygeal vertebrae(4.0%).The associated injuries were located at chest(163 regions,38.6%),abdomen(84 regions,19.9%),head and neck(77 regions,18.3%),extremity(65 regions,15.4%),face(17 regions,4.0%)and body surface(16 regions,3.8%).The early complications included electrolyte disturbances in 33 patients (16.8%),respiratory infection in 30(15.3%)and abdominal distention in 19(9.7%).The late complications were malnutrition in 26 patients(13.3%),amyotrophy in 23(11.7%)and deep vein thrombus in 11(5.6%).Treatment methods were operations and expectant treatments in 106 patients (74.1%)and 37(25.9%)respectively.According to American Spinal Injury Association(ASIA)scale,there were 20 patients(14.0%)at grade E before treatment and 53(37.1%)at grade E after treatment.Of all,12 patients were died of mainly multiple organ failure(MOF),cerebral hernia and malnutrition,with mortality rate of 8.39%.There showed an increase of complication and mortality rate with increase of ASIA grade(P ＜ 0.05).Conclusions The spine and spinal cord injuries in patients with multiple trauma are mainly caused by high energy injuries and characterized by high injury severity,complex associated injuries,multiple complications,difficult management and high mortality rate.
