早期整体治疗模式在合并胸腰椎骨折多发伤患者中的应用  

Clinical application of early total care in polytrauma patients combined with thoracolumbar fractures

作　　者：郭炯炯[1] 张铭昊 吴恺伦 田一星[1] 张勇[1] 陈洁[1] 刘凌[1] 肖锦春 毛海青[1] 杨惠林[1] Guo Jiongjiong;Zhang Minghao;Wu Kailun;Tian Yixing;Zhang Yong;Chen Jie;Liu Ling;Xiao Jinchun;Mao Haiqing;Yang Huilin(Department of Orthopedics,First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院骨科,江苏省苏州市215006 [2]盐城市中医院骨科 [3]苏州独墅湖医院/苏州大学医学中心骨科 [4]张家港市第三人民医院骨科

出　　处：《中华创伤杂志》2018年第12期1127-1131,共5页Chinese Journal of Trauma

基　　金：江苏省“六大人才高峰”计划(WSW-041);江苏省青年医学人才(QNRC2015710).

摘　　要：目的探讨早期整体治疗模式(ETC)治疗合并胸腰椎骨折多发伤患者的效果。方法采用回顾性病例对照研究分析2012年1月-2015年10月苏州大学附属第一医院和张家港市第三人民医院收治的137例合并胸腰椎骨折多发伤患者临床资料,其中男90例,女47例;年龄26-69岁,平均48.2岁。根据治疗模式将患者分为ETC组(59例)和传统治疗模式(TMC)组(78例)。ETC组ISS为(22.15±9.28)分,TMC组ISS为(23.37±10.74)分。ETC组由多学科医师共同对患者状况进行评估,制定个体化治疗方案使患者在伤后早期接受手术治疗。TMC组优先稳定患者病情,或转专科治疗,评估平稳后再择期行手术治疗。患者均采用传统后路椎弓根钉内固定术治疗,对于爆裂骨折合并神经损伤的患者行后路椎管减压。比较两组胸腰椎损伤分类及损伤程度评分系统(TLICS)评分、脊柱载荷分享评分(LSC)、术前术后格拉斯哥昏迷评分(GCS)、Frankel分级、住院时间及术后并发症情况等。结果ETC组TLICS评分显著低于TMC组(P<0.05)。两组LSC差异元统计学意义(P>0.05)。ETC组和TMC组的住院时间[(11.8±3.7)d:(17.5±4.5)d]、压疮发生率(5%:21%)及伤口感染率(17%:15%)比较,差异有统计学意义(P<0.05)。两组肺部感染、下肢深静脉血栓等并发症发生率差异元统计学意义(P>0.05)。术前两组GCS差异无统计学意义(P>0.05),术后TMC组GCS显著高于ETC组(P<0.01),且两组术后GCS较术前显著增高(P<0.05)。ETC组术后Frankel分级:A级1例,B级1例,C级3例,D级4例,E级2例,优良好转率为82%;TMC组术后Frankel分级:A级3例,B级3例,C级3例,D级4例,E级4例,优良好转率为65%。结论与TMC比较,采用ETC治疗合并胸腰椎骨折的多发伤患者可有效缩短住院时间,降低压疮发生率,更有利于神经功能的恢复,但伤口感染风险较高。而对于TLICS评分较高的不稳定胸腰椎骨折患者,仍优先采用TMC模式治疗。Objective To evaluate the clinical application of early total care (ETC)for polytranma patients combined with thoracolumbar fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 137polytrauma patients combined with thoracolumbar fractures admitted to the First Affiliated Hospital of Soochow University and the Third People's Hospital of Zhangjiagang from January 2012 to October 2015.There were 90 males and 47 females,aged 26-69 years, with an average age of 48.2 years.The patients were divided into ETC group (n=59)and TMC group (n=78).In the ETC group,physicians from different departments evaluated the patients and developed individualized therapeutic regimens to allow the patients to undergo surgery at early stage after injury.The TMC group preferentially stabilized the patient 's condition or transferred the patients to specialist treatment,and then the surgery was performed electively after the condition of the patient was stable.The ISS of the ETC group was (22.15±9.28)points,and that of the TMC group was (23.37±10.74) points.All patients underwent conventional posterior pedicle screw internal fixation.For patients with burst fracture and nerve injury,posterior spinal canal decompression was performed.The thoracolumbar injury classification and severity score (TLICS),spinal load sharing classification (LSC),preoperative and postoperative Glasgow coma score (GCS),Frankel classification,hospitalization time and postoperative complications were compared between the two groups.Results The TLICS scores of ETC group were significantly lower than those of TMC group (P<0.05)while the LSC scores showed no significant differences between the two groups (P>0.05).ETC group had shorter hospitalization time [(11.8± 3.7)days :(17.5±4.5)days]and lower pressure ulcer incidence [(5%:21%)]than the TMC group (P<0.05 or 0.01),but the former had significantly higher wound infection rate [(17%:15%)](P<0.05).There was no significant difference in pulmonary infection and deep venous thr

关 键 词：脊柱骨折 多处创伤 治疗结果 

分 类 号：R683.2[医药卫生—骨科学]