“5·12”汶川大地震中合并有多发伤的脊柱骨折的临床特点和治疗
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摘要
目的:总结汶川大地震期间合并有多发伤的脊柱骨折的临床特点和治疗经验。方法:回顾分析汶川大地震期间四川大学华西医院收治的281例脊柱骨折,其中223例合并有多发伤,分析其临床特点和治疗方式。结果:223例合并多发伤的脊柱骨折中单纯椎体骨折138例,单纯附件损伤37例,椎体+附件骨折48例;平均年龄43.45±14.05岁;椎体分布以下胸段和腰段为主,胸腰段占60%左右;致伤原因中砸伤占82.1%;脊柱手术治疗35例,占需手术治疗的27.8%;合并伤共267例次;严重并发症127例次;合并脊髓或马尾神经损伤101例,占45.3%,有15例在搬运中发生脊髓损伤。结论:汶川大地震发生在山区,地震烈度高,伤员多为复合伤,存在严重的并发症,受累椎体多,治疗的重点首先放在处理开放伤、感染、并发症上,影响了脊柱骨折的治疗;早期救援时正确施救才能有效防范继发性脊髓损伤。
Objective:To summarize the clinical feature and treatment of spinal fractures with multiple injury in "5·12" Wenchuan Earthquake.Methods:281 cases with spinal fractures treated in West China Hospital during Wenchuan Earthquake were retrospectively analyzed.There were 223 cases with multiple injury.Results:In the 223 cases,138 were single vertebral body fracture,37 single accessory fracture,and 48 vertebral and accessory fractures.Average ages were 43.45±14.05 years old.Thoracolumbar fractures were 60 percent in all spinal fractures.The cause of fracture mostly were smash.There were 35 cases be operated which were 27.8 percent in all cases who need operation.There were 267 cases with multiple injury and 127 cases with serious complication.There were 101 cases with spinal cord injury or Cauda equina nerves injury,and 15 cases suffered spinal cord injury during transportation.Conclusion:There were many multiple injury and serious complication in Wenchuan Earthquake.The most important attention were to deal with wounds,infections and complications which delay to treatment of spinal fractures.The chief manner is correct first aid early which can be keep away secondary spinal cord injury.
Objective:To summarize the clinical feature and treatment of spinal fractures with multiple injury in "5·12" Wenchuan Earthquake.Methods:281 cases with spinal fractures treated in West China Hospital during Wenchuan Earthquake were retrospectively analyzed.There were 223 cases with multiple injury.Results:In the 223 cases,138 were single vertebral body fracture,37 single accessory fracture,and 48 vertebral and accessory fractures.Average ages were 43.45±14.05 years old.Thoracolumbar fractures were 60 percent in all spinal fractures.The cause of fracture mostly were smash.There were 35 cases be operated which were 27.8 percent in all cases who need operation.There were 267 cases with multiple injury and 127 cases with serious complication.There were 101 cases with spinal cord injury or Cauda equina nerves injury,and 15 cases suffered spinal cord injury during transportation.Conclusion:There were many multiple injury and serious complication in Wenchuan Earthquake.The most important attention were to deal with wounds,infections and complications which delay to treatment of spinal fractures.The chief manner is correct first aid early which can be keep away secondary spinal cord injury.
引文
[1]黄润秋.“5.12”汶川大地震地质灾害的基本特征及其对灾后重建影响的建议[J].中国地质教育,2008,17(2):21-24.
[2]胥少汀.脊髓损伤治疗的主要环节[J].中国脊柱外科杂志,2004,2(1):56-60.
[3]RATHORE MF,RASHID P,BUTT AW,et al.Epidemiology ofspinal cord injuries in the 2005 Pakistan earthquake[J].SpinalCord,2007,45(10):658-663.
[4]PRIEBE MM.Spinal cord injuries as a result of earthquakes:les-sons from Iran and Pakistan[J].J Spinal Cord Med,2007,30(4):367-368.
[5]KRAEMER WJ,SCHEMITSCH EH,LEVER J,et al.Func-tional outcome of thoracolumbar burst fractures without neurologi-cal deficit[J].J Orthop Trauma,1996,10(8):541-544.
[6]ESSES SI,BOTSFORD DJ,KOSTUIK JP.Evaluation of surgicaltreatment for burst fractures[J].Spine,1990,15(7):667-673.
[7]DENIS F.The three column spine and its significance in the classi-fication of acute thoracolumbar spinal injuries[J].Spine,1983,8(8):817-831.
[8]王正国.地震灾害的特点及其所致创伤的救治[J].中华创伤杂志,2008,24(6):401-404.
[9]BRACKEN MB,SHEPARD MJ,HOLFORD TR,et al.Admin-istration of methylprednisolone for 24 hours or tirilazad mesylatefor 48 hours in the treatment of acute spinal cord injury.Resultsof the third national acute spinal cord injury randomized controlledtrial[J].JAMA,1997,277(20):1597-1604.
[10]HEBERT JS,BURNHARM RS.The effect of ploytrauma in per-sons with traumatic spine injury.A prospective database of spinefractures[J].spine,2000,25(1):55-60.
[2]胥少汀.脊髓损伤治疗的主要环节[J].中国脊柱外科杂志,2004,2(1):56-60.
[3]RATHORE MF,RASHID P,BUTT AW,et al.Epidemiology ofspinal cord injuries in the 2005 Pakistan earthquake[J].SpinalCord,2007,45(10):658-663.
[4]PRIEBE MM.Spinal cord injuries as a result of earthquakes:les-sons from Iran and Pakistan[J].J Spinal Cord Med,2007,30(4):367-368.
[5]KRAEMER WJ,SCHEMITSCH EH,LEVER J,et al.Func-tional outcome of thoracolumbar burst fractures without neurologi-cal deficit[J].J Orthop Trauma,1996,10(8):541-544.
[6]ESSES SI,BOTSFORD DJ,KOSTUIK JP.Evaluation of surgicaltreatment for burst fractures[J].Spine,1990,15(7):667-673.
[7]DENIS F.The three column spine and its significance in the classi-fication of acute thoracolumbar spinal injuries[J].Spine,1983,8(8):817-831.
[8]王正国.地震灾害的特点及其所致创伤的救治[J].中华创伤杂志,2008,24(6):401-404.
[9]BRACKEN MB,SHEPARD MJ,HOLFORD TR,et al.Admin-istration of methylprednisolone for 24 hours or tirilazad mesylatefor 48 hours in the treatment of acute spinal cord injury.Resultsof the third national acute spinal cord injury randomized controlledtrial[J].JAMA,1997,277(20):1597-1604.
[10]HEBERT JS,BURNHARM RS.The effect of ploytrauma in per-sons with traumatic spine injury.A prospective database of spinefractures[J].spine,2000,25(1):55-60.
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