急诊手术治疗不稳定型胸腰椎骨折合并多发伤的安全性分析

Clinical safety of emergency surgical treatment for unstable thoracolumbar fracture combined with multiple trauma

中文关键词:  胸腰椎骨折  多发伤  急诊手术  疗效

英文关键词:Thoracolumbar fracture  Multiple injuries  Emergency surgery  Internal fixation  Effection

中文摘要:

  【摘要】 目的：探讨急诊手术治疗合并多发伤的不稳定型胸腰椎骨折的安全性。方法：回顾性分析我院2015年1月~2018年3月收治的51例合并多发伤的不稳定型胸腰椎骨折患者的临床资料，男40例，女11例；年龄18～60岁（36.0±4.9岁）。高处坠落34例，车祸11例，重物砸伤6例。合并胸部损伤26例，腹部损伤17例，头部损伤16例，上肢损伤13例，下肢损伤9例，颈部损伤1例，面部损伤1例，体表损伤1例。其中21例对胸腰椎骨折行急诊手术治疗（急诊组），30例行择期手术治疗（择期组）。两组患者性别比、受伤机制、损伤严重程度（ISS）评分、胸腰椎骨折椎体数和AO分型、神经功能损伤Frankel分级均无统计学差异（P>0.05），比较两组患者的手术时间、术中出血量、术后伤口引流量、ICU监护时间、输血量、住院时间、神经功能恢复情况、手术并发症发生率、术前术后伤椎矢状位Cobb角、术前术后伤椎前缘高度压缩率、术后Oswestry功能障碍指数（ODI）和伤椎椎管狭窄率改善情况。结果：急诊组术前伤椎前缘高度压缩率、伤椎椎管狭窄率显著高于择期组，差异有统计学意义（P<0.05）。急诊组手术时间、术后伤口引流量、ICU监护时间、术前术后伤椎矢状位Cobb角、术后1个月的伤椎前缘高度压缩率和伤椎椎管狭窄率、并发症发生率与择期组比较均无统计学差异（P>0.05）。急诊组术中出血量较大，住院时间较短，术后1个月ODI较低，神经损伤改善情况（Frankel分级）更明显，与择期组比较均有统计学差异（P＜0.05）。结论：对合并多发伤的不稳定型胸腰椎骨折行急诊手术治疗相对安全、有效，能够减少住院时间，有益于患者神经功能恢复；但术中出血量较大。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety of emergency surgical treatment for unstable thoracolumbar fracture combined with multiple trauma. Methods: A retrospective analysis was performed on 51 patients underwent treatment for unstable thoracolumbar fracture combined with multiple trauma between January 2015 and March 2018. There were 40 males and 11 females, with a mean age of 36±4.9 years(ranged 18 to 60 years). Among them, 34 cases were injured by high fall, 11 cases by traffic accidents, and 6 cases by heavy objects. There were 26 cases of chest injury, 17 cases of abdominal injury, 16 cases of head injury, 13 cases of upper limbs injury, 9 cases of lower limbs injury, 1 case of neck injury, 1 case of facial injury, and 1 case of body surface injury. 21 patients were treated with emergency group and 30 patients were underwent elective group. There were no statistically significant differences between the two groups in gender ratio, injury mechanism, ISS score, thoracolumbar fracture vertebral body number and AO classification, and Frankel classification of neurological impairment. We compared the statistical difference of operation time, intraoperative blood loss, amount of wound drainage, ICU monitoring time, hospital stays, recovery of neurological function(Frankel grade), complications, pre- and postoperative sagittal Cobb angle, pre- and postoperative compression rate of anterior edge, pre-and postoperative rate of spinal stenosis of injured vertebrae between the two groups. Results: The high compression rate of the anterior edge of the injured vertebra and the rate of spinal stenosis of the injured vertebra before surgery in emergency group were significantly higher than those in elective group, with statistically significant differences(P<0.05). There were no statistically significant differences between emergency group and elective group in operation time, postoperative wound drainage volume, ICU monitoring time, sagittal Cobb angle of injured vertebra, high compression rate of anterior edge of injured vertebra, rate of postoperative injured vertebra stenosis, and incidence of complications one month after operation(P>0.05). In addition, compared with elective group, there were statistically significant differences in intraoperative blood loss, hospital stay, and postoperative ODI, improvement of nerve injury(Frankel grade) in emergency group(P<0.05). Conclusions: Emergency surgery for unstable thoracolumbar fractures with multiple injuries is relatively safe and effective, and can reduce the length of hospital stay. It is beneficial to the recovery of neurological function, but also increases the amount of intraoperative blood loss.