汶川大地震伤员脊柱损伤伤情分析
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摘要
目的分析汶川大地震伤员脊柱损伤情况及临床特点。方法5.12汶川大地震共收治146例脊柱损伤伤员,男79例,女67例;年龄11～88岁,平均51岁;收集其临床资料的相关数据,作流行病学分析。排除年龄<16岁者2例、单纯脊柱附件(棘突、横突、椎板)骨折15例、无法纳入Denis分型的AO分型为A2型骨折1例及上颈椎损伤患者9例,余119例患者纳入分析,按年龄分为两组:年龄<60岁组(A组)78例,男40例,女38例;年龄18～58岁,平均41岁。年龄≥60岁组(B组)41例,男24例,女17例;年龄60～88岁,平均71岁。将两组资料进行比较。结果导致脊柱损伤的主要原因是高处坠落伤(27.40%)及重物砸伤(67.81%);骨折类型按Denis分型以爆裂骨折(54.62%)和压缩骨折(33.61%)为主;有31.51%的患者发生了较严重的神经损伤(根据ASIA脊髓损伤分级为A、B、C级者);受伤部位最多见于胸腰椎(78.77%);有52.74%的患者并发了其他部位损伤,以肢体骨折(30.14%)和肋骨骨折(19.86%)最多见;有22.60%的患者发生了多发脊柱损伤。比较A、B两组临床资料,A组发生高处坠落伤的比例(34.62%)远高于B组(12.20%);A组骨折类型以爆裂骨折(58.97%)最多见,B组以压缩骨折(48.78%)最多见;B组严重神经损害的比例(24.39%)明显低于A组(44.87%);B组复合伤的比例(70.73%)明显高于A组(43.59%);B组发生多个椎体损伤的比例(39.02%)明显高于A组(21.79%);两组各项临床资料比较差异均有统计学意义(P<0.05)。结论汶川大地震伤员脊柱损伤的主要原因为重物砸伤及高处坠落伤,骨折类型以压缩骨折和爆裂骨折为主,发生脊髓损伤、复合伤、多个椎体损伤的比例高。
Objective To analyze the spinal injury in Wenchuan earthquake and to investigate its clinical features.Methods Data of 146 patients in Wenchuan earthquake with spinal injuries(79 males,67 females;aged 11-88 years old,average 51 years old) were collected and analyzed epidemiologically.Two patients under 16 years of age,15 patients with the fractures of spinous process,transverse process or vertebra lamina,1 patient with spinal fractures of type A2 according to AO classification but no corresponding type in Denis classification,and 9 patients with upper cervical injuries were excluded.The remaining 119 patients were divided into two groups according to their age:group A in which 78 patients were under 60 years of age,including 40 males and 38 females aged 18-58 years old(average 41 years old),and group B in which 41 patients were 60 years of age or above,including 24 males and 17 females aged 60-88 years old(average 71 years old).Analyses for the two groups were compared.Results The leading causes of spinal injuries were fall from high places(27.40%) and crush by heavy objects(67.81%).According to Denis classification,the major types of spinal injuries were burst fracture(54.62%) and compression fracture(33.61%).Serious nerve injury,defined as grade A,B and C in ASIA neurological function assessment,occurred in 31.51% of patients.The most common injured site was in thoracic or lumbar vertebrae(78.77%),and 52.74% of patients had combined injuries,among which the fractures of limb(30.14%) and rib(19.86%) were the most common.Multi-level spinal fractures happened to 22.60% of patients.Comparative analysis revealed the rate of injury caused by fall from high places in group A(34.62%) was much higher than that in group B(12.20%).The commonest type of fracture in group A was burst fracture(58.97%),and it was compression fracture in group B(48.78%).The rate of serious nerve injury in group B(24.39%) was much lower than that in group A(44.87%).The rate of combined injury and multilevel vertebral body injury in group B was 70.73% and 39.02%,respectively,which was much higher than that in group A(combined injury 43.59%;multilevel vertebral body injury 21.79%).There were significant differences between two groups in all the indicators derived from clinical data(P < 0.05).Conclusion In Wenchuan earthquake,the leading causes of spinal injuries are fall from high places and crush by heavy objects,the major types of fracture are compression fracture and burst fracture,and the occurrencerates of spinal injury,combined injury and multilevel vertebral body injury are high.
Objective To analyze the spinal injury in Wenchuan earthquake and to investigate its clinical features.Methods Data of 146 patients in Wenchuan earthquake with spinal injuries(79 males,67 females;aged 11-88 years old,average 51 years old) were collected and analyzed epidemiologically.Two patients under 16 years of age,15 patients with the fractures of spinous process,transverse process or vertebra lamina,1 patient with spinal fractures of type A2 according to AO classification but no corresponding type in Denis classification,and 9 patients with upper cervical injuries were excluded.The remaining 119 patients were divided into two groups according to their age:group A in which 78 patients were under 60 years of age,including 40 males and 38 females aged 18-58 years old(average 41 years old),and group B in which 41 patients were 60 years of age or above,including 24 males and 17 females aged 60-88 years old(average 71 years old).Analyses for the two groups were compared.Results The leading causes of spinal injuries were fall from high places(27.40%) and crush by heavy objects(67.81%).According to Denis classification,the major types of spinal injuries were burst fracture(54.62%) and compression fracture(33.61%).Serious nerve injury,defined as grade A,B and C in ASIA neurological function assessment,occurred in 31.51% of patients.The most common injured site was in thoracic or lumbar vertebrae(78.77%),and 52.74% of patients had combined injuries,among which the fractures of limb(30.14%) and rib(19.86%) were the most common.Multi-level spinal fractures happened to 22.60% of patients.Comparative analysis revealed the rate of injury caused by fall from high places in group A(34.62%) was much higher than that in group B(12.20%).The commonest type of fracture in group A was burst fracture(58.97%),and it was compression fracture in group B(48.78%).The rate of serious nerve injury in group B(24.39%) was much lower than that in group A(44.87%).The rate of combined injury and multilevel vertebral body injury in group B was 70.73% and 39.02%,respectively,which was much higher than that in group A(combined injury 43.59%;multilevel vertebral body injury 21.79%).There were significant differences between two groups in all the indicators derived from clinical data(P < 0.05).Conclusion In Wenchuan earthquake,the leading causes of spinal injuries are fall from high places and crush by heavy objects,the major types of fracture are compression fracture and burst fracture,and the occurrencerates of spinal injury,combined injury and multilevel vertebral body injury are high.
引文
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11Roy DK,O’Neill TW,Finn JD,et al.Determinants of incident vertebral fracture in men and women:results from the European Prospective Osteoporosis Study(EPOS).Osteoporos Int,2003,14(1):19-26.
12Adachi JD,Ionnidis G,Berger C,et al.The in-uence of osteoporotic fractures on health related quality of life in community dwelling men and women across Canada.Osteoporos Int,2001,12(11):903-908.
13O’Connor PA,Eustace S,O’Byrne J.Spinal cord injury following osteoporotic vertebral fracture:case report.Spine,2002,27(18):E413-415.
14Heggeness MH.Spine fracture with neurological deficit in osteoporo-sis.Osteoporos Int,1993,3(4):215-221.
15Huntoon E,Sinaki M.Thoracic osteoporotic fracture without upper thoracic pain.Am J Phys Med Rehabil,2004,83(9):729.
16Kim DH,Vacaro AR.Osteoporotic compression fractures of the spine:current options and considerations for treatment.Spine J,2006,6(5):479-487.
17Peek-Asa C,Ramirez M,Shoaf K,et al.Population-based case-control study of injury risk factors in the northridge earthquake.Ann Epide-miol,2002,12(7):525-526.
18Tanida N.What happened to elderly people in the great Hanshin earthquake.BMJ,1996,313(7065):1133-1135.
2Kantarci G,Vanholder R,Tuglular S,et al.Acute renal failure due to crush syndrome during Marmara earthquake.Am J Kidney Dis,2002,40(4):682-689.
3Iskit SH,Alpay H,Tu-tepe H,et al.Analysis of33pediatric trauma victims in the1999Marmara,Turkey earthquake.J Pediatr Surg,2001,36(2):368-372.
4Sheng ZY.Medical support in the Tangshan earthquake:a review of the management of mass casualties and certain major injuries.J Trau-ma,1987,27(10):1130-1135.
5Bulut M,Fedakar R,Akkose S,et al.Medical experience of a university hospital in Turkey after the1999Marmara earthquake.Emerg Med J,2005,22(7):494-498.
6Denis F.The three column spine and its significance in the classifica-tion of acute thoracolumbar spinal injuries.Spine,1983,8(8):817-831.
7American Spinal Injury Association.Standards for neurological clas-sification of spinal injury patients.Chicago:American Spinal Injury Association,1984.
8Roche SJ,Sloane PA,McCabe JP.Epidemiology of spine trauma in an Irish regional trauma unit:a4-year study.Injury,2008,39(4):443-450.
9Kuwagata Y,Oda J,Tanaka H,et al.Analysis of2,702traumatized patients in the1995Hanshin-Awaji earthquake.J Trauma,1997,43(3):427-432.
10Tahmasebi M,Kiani K,Mazlouman SJ,et al.Musculoskeletal injuries associated with earthquake.A report of injuries of Iran’s December26,2003Bam earthquake casualties managed in tertiary referral centers.Injury,2005,36(1):27-32.
11Roy DK,O’Neill TW,Finn JD,et al.Determinants of incident vertebral fracture in men and women:results from the European Prospective Osteoporosis Study(EPOS).Osteoporos Int,2003,14(1):19-26.
12Adachi JD,Ionnidis G,Berger C,et al.The in-uence of osteoporotic fractures on health related quality of life in community dwelling men and women across Canada.Osteoporos Int,2001,12(11):903-908.
13O’Connor PA,Eustace S,O’Byrne J.Spinal cord injury following osteoporotic vertebral fracture:case report.Spine,2002,27(18):E413-415.
14Heggeness MH.Spine fracture with neurological deficit in osteoporo-sis.Osteoporos Int,1993,3(4):215-221.
15Huntoon E,Sinaki M.Thoracic osteoporotic fracture without upper thoracic pain.Am J Phys Med Rehabil,2004,83(9):729.
16Kim DH,Vacaro AR.Osteoporotic compression fractures of the spine:current options and considerations for treatment.Spine J,2006,6(5):479-487.
17Peek-Asa C,Ramirez M,Shoaf K,et al.Population-based case-control study of injury risk factors in the northridge earthquake.Ann Epide-miol,2002,12(7):525-526.
18Tanida N.What happened to elderly people in the great Hanshin earthquake.BMJ,1996,313(7065):1133-1135.
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