胸腰段脊柱脊髓伤合并胸腹脏器伤的诊断和治疗  

Diagnosis and treatment of thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injury

作　　者：苟景跃[1] 李帮春[1] 王珏[1] 

机构地区：[1]重庆市急救医疗中心骨科,400014

出　　处：《中华创伤杂志》2005年第3期176-177,共2页Chinese Journal of Trauma

摘　　要：目的探讨胸腰段脊柱脊髓伤合并胸腹脏器伤的诊断和治疗. 方法回顾性分析我院1986年1月-2002年12月收治的此类伤84例.其中胸椎骨折(T6～T12)52例,腰椎骨折32例(L1～L4),合并胸部损伤70例,合并腹部损伤14例,合并颅脑、四肢骨盆损伤34例.脊柱固定脊髓减压手术62例,胸腔引流术22例,剖腹手术10例,开颅手术9例. 结果本组生存82例,随访6～36个月.神经功能恢复情况按Frankel标准:A级36例中部分或感觉恢复10例,其余神经功能均比术前改善1～3级.延误诊断及漏诊7例(12%),2例死于术后多器官功能障碍综合征(MODS). 结论对胸腰段脊柱脊髓伤合并胸腹脏器伤的患者应全面仔细地体检及X线或CT检查.救治应优先处理危及生命的胸腹伤,同时避免加重脊柱脊髓损伤.Objective To explore diagnosis and treatment of thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injury. Methods A retrospective study was performed on 84 cases with thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injuries treated in our unit from January 1986 to December 2002, of which there were 52 cases with thoracic vertebra fracture (T_6-T_(12)), 32 with lumbar fracture (L_1-L_4), 70 with complicated chest injury, 14 with abdominal injury and 34 with injuries of cranium, extremities and pelvis. Spinal fixation or decompression of spinal cord was performed in 62 cases, drainage in 22, laparotomy in 10 and exploration of skull in nine. Results Eighty-two cases survived, with follow up period for 6-36 months. According to Frankel standard nerve function recovery showed that among 36 cases at grade A, 10 had partial or sensation recovery and the other got nerve function improvement for gradeⅠ-Ⅲ. Delayed diagnosis and missed injuries totaled seven cases (12%). Two cases were died of postoperative MODS. Conclusions As for patients with thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injury, a comprehensive clinical examination including X-ray or CT is necessary. The treatment should first focus on thoracoabdominal viscera trauma and try to avoid aggravation of spine and spinal cord injury.

关 键 词：胸腰段脊柱脊髓伤 胸腹脏器伤 诊断 治疗 并发症 

分 类 号：R651.3[医药卫生—外科学] R641[医药卫生—临床医学]