腰5横突骨折与骨盆骨折稳定性及腹腔组织损伤的相关性研究
|
摘要
目的:探讨骨盆患者中,腰5横突骨折与骨盆骨折稳定性及腹腔组织损伤的关系。方法:回顾性分析183例因骨盆骨折收治入院患者的骨盆及腹腔多层螺旋CT表现,按照Tile分型对各患者骨盆骨折情况进行分类,并探讨腰5横突骨折与骨盆骨折稳定性及合并盆腹腔脏器损伤的相关性。结果:(1)51例患者腰5横突骨折,其中A型骨折2例(2/37,5.4%),B型17例(17/101,16.8%),C型骨折32例(32/45,71.1%);L5横突骨折在C型患者中发生率明显高于A型及B型患者,差异有统计学意义(P<0.001),其预测骨折稳定性的比值比(odds ratio,OR)为8.84;(2)59例患者腹腔组织脏器损伤,其中20例合并腰5横突骨折,7例合并非腰5横突骨折(椎体、椎弓根及棘突),3例同时合并腰5椎体及横突骨折,29例未见腰椎骨折。合并腰5横突骨折患者腹部脏器损伤的发生率明显增高(P<0.05),其预测腹部脏器损伤的的OR值为3.52;合并腰5横突骨折患者的腹部损伤严重度评分明显高于非腰5横突骨折患者患者(3.58±0.89 vs.2.93±0.55,P=0.005)。结论:腰5横突骨折与骨盆骨折的稳定性及是否合并盆腹腔脏器损伤相关,并可作为预测骨盆骨折稳定性、合并盆腹腔脏器损伤及其严重程度的预测因素。
Objective:To determine whether L5 transverse process fractures (TPF) in patients had pelvic fracture is associated with pelvic fracture instability and abdominal organ injuries.Methods:183 consecutive patients with pelvic fracture were enrolled into this study and divided into 3 groups according to Tile classification,to investigate the correlation between L5 TPF with pelvic fracture instability and abdominal organ injuries.Results:Among 51 pelvic fracture patients,2 (2/37,5.4%),17 (17/101,16.8%) and 32 (32/45,71.1%) had type A,B and C pelvic fracture,respectively.The incidence of L5 transverse process fracture was significantly higher in patients with Type C pelvic fracture compared with Type A and B patients,the difference was statistically significant (P < 0.001).The odds ratio for an unstable fracture of the pelvis was 8.84.59 of the pelvic fracture patients associated with abdominal organ injuries.Among these patients,20 with transverse process fractures,7 had non-transverse process (NTP) fractures only (including vertebral body,pedicle,or spinous process fractures),3 had both L5 transverse process and NTP fractures,and 29 without Lumbar fracture.The incidence of abdominal organ damage was significantly higher in patients with both L5 transverse process and NTP fractures (P <0.05),and the OR value of predicting abdominal visceral injuries was 3.52.Patients with transverse process fractures and abdominal organ injuries had an increased Abbreviated Injury Scale (AIS) score (3.58 ± 0.89 vs.2.93 ± 0.55,P = 0.005) compared with patients with NTP fractures and abdominal organ injuries.Conclusion:A fracture of the transverse process of L5 in the presence of a pelvic fracture is associated with an increased risk of instability of the pelvic fracture,and should be regarded as a significant marker for abdominal organ injuries in patients with pelvic fracture.
Objective:To determine whether L5 transverse process fractures (TPF) in patients had pelvic fracture is associated with pelvic fracture instability and abdominal organ injuries.Methods:183 consecutive patients with pelvic fracture were enrolled into this study and divided into 3 groups according to Tile classification,to investigate the correlation between L5 TPF with pelvic fracture instability and abdominal organ injuries.Results:Among 51 pelvic fracture patients,2 (2/37,5.4%),17 (17/101,16.8%) and 32 (32/45,71.1%) had type A,B and C pelvic fracture,respectively.The incidence of L5 transverse process fracture was significantly higher in patients with Type C pelvic fracture compared with Type A and B patients,the difference was statistically significant (P < 0.001).The odds ratio for an unstable fracture of the pelvis was 8.84.59 of the pelvic fracture patients associated with abdominal organ injuries.Among these patients,20 with transverse process fractures,7 had non-transverse process (NTP) fractures only (including vertebral body,pedicle,or spinous process fractures),3 had both L5 transverse process and NTP fractures,and 29 without Lumbar fracture.The incidence of abdominal organ damage was significantly higher in patients with both L5 transverse process and NTP fractures (P <0.05),and the OR value of predicting abdominal visceral injuries was 3.52.Patients with transverse process fractures and abdominal organ injuries had an increased Abbreviated Injury Scale (AIS) score (3.58 ± 0.89 vs.2.93 ± 0.55,P = 0.005) compared with patients with NTP fractures and abdominal organ injuries.Conclusion:A fracture of the transverse process of L5 in the presence of a pelvic fracture is associated with an increased risk of instability of the pelvic fracture,and should be regarded as a significant marker for abdominal organ injuries in patients with pelvic fracture.
引文
[1]Starks I,Frost A,Wall P,et al.Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability[J].J Bone Joint Surg Br,2011,93(7):967-969.
[2]ChmelováJ,D6upa V,Procházka B,et al.Fractures of the L5 transverse process in pelvic ring injury[J].Acta Chir Orthop Traumatol Cech,2011,78(1):46-48.
[3]Miller CD,Blyth P,Civil ID.Lumbar transverse process fractures-a sentinel marker of abdominal organ injuries[J].Injury,2000,31(10):773-776.
[4]Lombardo G,Petrone P,Prabhakaran K,et al.Isolated transverse process fractures:insignificant injury or marker of complex injury pattern[J].Eur J Trauma Emerg Surg,2016,39(12):1-5.
[5]Tile M.Fractures of the pelvis and acetabulum[M].2nd ed,Baltimore:Williams and Wilkins,1995:1-26.
[6]Guthrie HC,Owens RW,Bircher MD.Fractures of the pelvis[J].J Bone Joint Surg Br,2010,92(11):1481-1488.
[7]李明,徐荣明,郑琦,等.临床容易忽视的隐匿性骨盆后环损伤的诊断及意义[J].中国骨伤,2008,21(11):810-813.
[8]李飞鹏,李明,华群,等.螺旋CT重建技术在骨盆环骨折中的诊治价值[J].中国骨伤,2010,23(3):204-207.
[9]Tile M.Acute pelvic fractures:I.Causation and classification[J].J Am Acad Orthop Surg,1996,4(3):143-151.
[10]陈亮,黄继锋,赵卫东,等.骨盆垂直不稳定性骨折的生物力学研究[J].中国临床解剖学杂志,2010,28(3):330-333.
[11]Kenawey M,Krettek C,Addosooki A,et al.Unstable paediatric pelvic injuries:the patho-anatomical patterns of pelvic ring failure and the role of avulsion of the iliac apophysis[J].Bone Joint J,2015,97-B(5):696-704.
[12]Bradley LH,Paullus WC,Howe J,et al.Isolated transverse process fractures:spine service management not needed[J].J Trauma,2008,65(4):832-836.
[13]Patten RM,Gunberg SR,Brandenburger DK.Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma[J].Radiology,2000,215(3):831-834.
[14]Krueger MA,Green DA,Hoyt D,et al.Overlooked spine injuries associated with lumbar transverse process fractures[J].Clin Orthop,1996,(327):191-195.
[2]ChmelováJ,D6upa V,Procházka B,et al.Fractures of the L5 transverse process in pelvic ring injury[J].Acta Chir Orthop Traumatol Cech,2011,78(1):46-48.
[3]Miller CD,Blyth P,Civil ID.Lumbar transverse process fractures-a sentinel marker of abdominal organ injuries[J].Injury,2000,31(10):773-776.
[4]Lombardo G,Petrone P,Prabhakaran K,et al.Isolated transverse process fractures:insignificant injury or marker of complex injury pattern[J].Eur J Trauma Emerg Surg,2016,39(12):1-5.
[5]Tile M.Fractures of the pelvis and acetabulum[M].2nd ed,Baltimore:Williams and Wilkins,1995:1-26.
[6]Guthrie HC,Owens RW,Bircher MD.Fractures of the pelvis[J].J Bone Joint Surg Br,2010,92(11):1481-1488.
[7]李明,徐荣明,郑琦,等.临床容易忽视的隐匿性骨盆后环损伤的诊断及意义[J].中国骨伤,2008,21(11):810-813.
[8]李飞鹏,李明,华群,等.螺旋CT重建技术在骨盆环骨折中的诊治价值[J].中国骨伤,2010,23(3):204-207.
[9]Tile M.Acute pelvic fractures:I.Causation and classification[J].J Am Acad Orthop Surg,1996,4(3):143-151.
[10]陈亮,黄继锋,赵卫东,等.骨盆垂直不稳定性骨折的生物力学研究[J].中国临床解剖学杂志,2010,28(3):330-333.
[11]Kenawey M,Krettek C,Addosooki A,et al.Unstable paediatric pelvic injuries:the patho-anatomical patterns of pelvic ring failure and the role of avulsion of the iliac apophysis[J].Bone Joint J,2015,97-B(5):696-704.
[12]Bradley LH,Paullus WC,Howe J,et al.Isolated transverse process fractures:spine service management not needed[J].J Trauma,2008,65(4):832-836.
[13]Patten RM,Gunberg SR,Brandenburger DK.Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma[J].Radiology,2000,215(3):831-834.
[14]Krueger MA,Green DA,Hoyt D,et al.Overlooked spine injuries associated with lumbar transverse process fractures[J].Clin Orthop,1996,(327):191-195.