老年人外伤性脊柱骨折的临床特点

Clinical characteristics of traumatic spinal fractures in elderly

中文关键词:  脊柱骨折  脊髓损伤  老年人  临床特点  性别差异  预防

英文关键词:Spinal fracture  Spinal cord injury  Elderly  Clinical characteristics  Sex differences  Prevention

中文摘要:

  【摘要】 目的：分析老年人外伤性脊柱骨折的临床特点，提高老年人外伤性脊柱骨折的预防及救治水平。方法：2002年1月～2011年12月我院收治老年人外伤性脊柱骨折患者271例，其中男129例，女142例，年龄60～89岁，平均68.8岁，分析其年龄与性别分布情况、骨折原因、骨折节段、创伤严重度评分（injury severity scores，ISS）、脊髓损伤程度ASIA分级、多发性脊柱骨折及合并伤发生率。结果：年龄分布主要集中在60～69岁，占60.1%(163/271)。摔伤是主要致伤原因，占44.6%（121/271）。男性高处坠落伤及重物砸伤比例较女性患者高，女性患者摔伤比例较男性高，差异有统计学意义（P<0.05）。426个损伤节段中胸椎及腰椎占80.8%（344/426），其中胸腰段（T11～L2）占53.3%（227/426）。男性患者较女性患者有较高的颈椎骨折比例、脊髓损伤发生率、合并症发生率和创伤严重度评分（ISS），差异有统计学意义（P<0.05）。女性患者较男性患者有较高的胸椎及胸腰段椎体骨折比例，差异有统计学意义（P<0.05）。男性患者多发性脊柱骨折最常见原因为高处坠落伤，女性患者为摔伤。脊髓损伤按ASIA分级，A级、B级、C级、D级分别占7.0%（19/271）、1.8%（5/271）、4.8%（13/271）和18.1%（49/271）。男性患者脊髓损伤分级A级占13.2%（17/129），女性患者为0.8%（2/237），两者差异有统计学意义（P<0.05）。结论：老年人外伤性脊柱骨折的致伤原因、多发性脊柱骨折原因、骨折节段、脊髓损伤分级等方面存在明显的性别差异，应根据其性别差异特点对老年人外伤性脊柱骨折进行防治。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical characteristics of traumatic spinal fractures in elderly and their prevention and intervention. Methods: A review of 271 cases(129 males and 142 females, aged from 60 to 89 years old, mean age 68.8 years old） suffering from spinal fractures treated in our hospital from January 2002 to December 2011 were undertaken. The distributions of age and sex, causes of fractures, fractured levels, injury severity scores, spinal cord injury according to American Spinal Injury Association(ASIA) classification and frequencies of multiple spinal fractures and associated injuries were analyzed retrospectively. Results: The 60 to 69 year-old patients formed the largest group, accounting for 60.1％(163/271). Falling was the main cause of traumatic spinal fracture, accounting for 44.6％(121/271). Frequencies of high falling and direct collision with a blunt object in male patients were significantly higher than the female(P<0.05). Frequencies of low falling in female patients were significantly higher than the male(P<0.05). There were 426 vertebral body fractures, thoracic and lumbar vertebral bodies accounting for 80.8%(344/426), in which thoracolumbar segment accounting for 53.3%(227/426). Frequencies of cervical spinal fractures, spinal cord injury, associated injury and the injury severity scores(ISS) in the male were higher than the female(P<0.05). Frequencies of thoracic and thoracolumbar spinal fractures in the female were higher than the male(P<0.05). The main cause of multiple spinal fractures was high falling in the male and low falling in the female. According to ASIA scale, the rate of spinal cord in level A, B, C and D was 7.0%(19/271), 1.8%(5/271), 4.8%(13/271) and 18.1%(49/271) respectively. Patients with level ASIA A accounted for 13.2%(17/129） in male and 0.8%(2/237) in female, and there was a significant difference（P<0.05）. Conclusions: There were significant sex differences in causes of total traumatic spinal fractures and multiple spinal fractures, fracture segments, ASIA scale and so on, we should make the prevention and treatment according to the sex differences of clinical characteristics of traumatic spinal fractures among the elderly.