36例地震所致脊柱骨折患者特点及治疗
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摘要
目的:探讨36例地震伤所致脊柱骨折的特点及治疗方法。方法:对"5.12"汶川地震中36例脊柱骨折患者的部位、分型、合并伤及治疗方法进行总结,对27例患者进行手术治疗,采用M cA fee分型系统对骨折进行分型,对有神经症状的患者采用美国脊柱损伤协会(am erican sp inal in jury assoc iation,ASIA)脊髓损伤分级评判。结果:36例脊柱骨折患者中共有43个椎体骨折。其中胸腰段椎体骨折35个(81.4%),骶骨骨折3个(7.0%),下腰椎骨折3例(7.0%),颈椎骨折和上胸椎骨折各1例(2.3%)。其中7例患者有2个椎体骨折。29(80.6%)例患者有脊柱外的骨折。9例有神经症状患者的ASIA评分平均提高1.2级。26例术前无神经症状的患者均未出现神经症状,1例患者术后发生伤口浅部感染。结论:地震伤所致脊柱骨折的常见原因为砸伤和坠落伤,多为多发骨折。其中胸腰段骨折是最常见的损伤部位。手术有助于脊柱不稳和有神经损伤的患者恢复神经功能、重建脊柱的稳定性并且方便护理及搬运。
Objective: To analyze 36 cases of spinal fracture patients caused by Earthquake;to investigate the characteristics and optimal treatment method of this kind of fracture.Methods: The disposition,classification and treatment methods of 36 spinal fracture patients injured in WenChuan earthquake were summarized.27 cases were treated by operation.McAfee classification system is used for evaluation of spinal stability.Patients with neurological function impairment were evaluated by ASIA evaluation standard.Results: There are 43 vertebral body fractures in 36 cases of spinal fractures,among which there are 35(81.4%) vertebral body fractures in thoracolumbar spine,3(7.0%) cases of sacrum fractures,3(7.0%) cases of lower lumbar fractures,1(2.3%) case of cervical spine fracture and upper thoracic vertebral fracture respectively.7 patients had two vertebrae fractures.The mean postoperative improvement of 9 patients had some neurological impairment according to ASIA classification was 1.2 grades.26 patients with Grade E neurological status have no deterioration after operation or conservative treatment.There was 1 patient got a superficial infection.Conclusion: The most common modes of spinal fractures caused by earthquake are crash and falls.Spinal fractures caused by earthquake are usually multiple fractures.The most common injury location is thoracolumbar spine.Operation may restore neurological function,rehabilitate stabilization of mechanically unstable spine,and facilitate care and transport.
Objective: To analyze 36 cases of spinal fracture patients caused by Earthquake;to investigate the characteristics and optimal treatment method of this kind of fracture.Methods: The disposition,classification and treatment methods of 36 spinal fracture patients injured in WenChuan earthquake were summarized.27 cases were treated by operation.McAfee classification system is used for evaluation of spinal stability.Patients with neurological function impairment were evaluated by ASIA evaluation standard.Results: There are 43 vertebral body fractures in 36 cases of spinal fractures,among which there are 35(81.4%) vertebral body fractures in thoracolumbar spine,3(7.0%) cases of sacrum fractures,3(7.0%) cases of lower lumbar fractures,1(2.3%) case of cervical spine fracture and upper thoracic vertebral fracture respectively.7 patients had two vertebrae fractures.The mean postoperative improvement of 9 patients had some neurological impairment according to ASIA classification was 1.2 grades.26 patients with Grade E neurological status have no deterioration after operation or conservative treatment.There was 1 patient got a superficial infection.Conclusion: The most common modes of spinal fractures caused by earthquake are crash and falls.Spinal fractures caused by earthquake are usually multiple fractures.The most common injury location is thoracolumbar spine.Operation may restore neurological function,rehabilitate stabilization of mechanically unstable spine,and facilitate care and transport.
引文
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[2]Dai LY,Yao WF,Cui YM,et al.Thoracolumbar fractures in pa-tients with multiple injuries:Diagnosis and treatment[J].J Trau-ma,2004,56(2):348-355.
[3]刘尚礼.重视胸腰段骨折治疗[J].中华创伤杂志,2006,22(1):5-7.
[4]Andrew MMS,Choll K,Michelle WBS,et al.Short-Segment Fix-ation of Lumbar Burst Fractures Using Pedicle Fixation at the Levelof the Fracture[J].Spine,2007,32(14):1503-1507.
[5]Chow GH,Nelson BJ,Gebhard JS,et al.Functional outcome ofthoracolumbar burst fractures managed with hyperextension castingor bracing and early mobilization[J].Spine,1996,21(18):2170-2175.
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