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

English Keywords:Thoracolumbar fracture  Multiple injuries  Emergency surgery  Internal fixation  Effection

English Abstract:

  【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.