伴完全性脊髓神经损伤胸腰椎骨折急诊手术的临床意义  

Clinical significance of emergency surgery in treatment of thoracolumbar fracture combined with complete spinal cord injury

作　　者：曾忠友[1] 吴鹏[1] 严卫锋[1] 张建乔[1] 姚小英[2] 宋永兴[1] 唐宏超[1] 韩建福[1] 

机构地区：[1]武警浙江省总队医院骨二科,武警部队骨科医学中心,嘉兴314000 [2]武警浙江省总队医院重症医学科,嘉兴314000

出　　处：《中华创伤杂志》2015年第6期484-489,共6页Chinese Journal of Trauma

摘　　要：目的探讨伴完全性脊髓神经损伤的胸腰椎骨折急诊手术治疗的临床意义及手术治疗策略。方法回顾性分析2006年1月—2012年12月采取手术治疗的伴完全性脊髓损伤且无严重合并伤（包括心、脑、肺及腹部脏器损伤）胸腰椎骨折患者56例。损伤部位：T5-8 1例，T6-7 2例，T7-8 4例，T10-11 7例，T11-12 10例，T12-L1 18例，L1-2 9例，L2-3 3例，T12 2例。按照新的AO分型：A3型2例，B2型9例，C型45例。按胸腰椎损伤分型及评分系统（TLICS）评分4—9分，平均8．0分。脊髓神经功能按Frankel分级均为A级。均采用后路椎弓根螺钉复位固定术，其中伤后6h内手术27例（急诊手术组），伤后4～7d手术29例（择期手术组）。比较两组手术时间、术中出血量、术后神经功能恢复、术后并发症以及术前、术后脊柱Cobb角、伤椎前缘高度恢复和椎管占位恢复情况。结果两组手术时间差异无统计学意义。择期手术组术中出血量少于急诊手术组[（775．7±354．1）ml：（985．3±391．8）m1]（P〈0．05）。急诊手术组出现下肢肿胀3例，尿路感染5例，肾积水4例；择期手术组出现骶尾部褥疮5例，下肢肿胀8例，尿路感染7例，肾积水5例。椎弓根螺钉系统无松动或断裂，植骨均获融合。急诊手术组、择期手术组术后脊柱Cobb角[（10．0±1．8）°：（11．4±1．9）°]、伤椎前缘高度丢失[（5．0±1．6）％：（5．3±1．8）％]及椎管占位[（10．2±2．5）％：（9．7±2．5）％]与术前比较[（28．6±8．9）°：（29．1±8．3）°、（36．1±16．4）％：（36．5±15．7）％、（82．5±10．7）％：（81．8±10．9）％]差异均有统计学意义（P〈0．05）。两组脊髓神经功能状态等级仍为A级。急诊手术组在脊髓损伤平面下降以及残余神经根功能恢复方面优于择期手术组。结论对于伴完全性脊髓损伤的胸腰椎骨折，急诊手术可以尽早控�Objective To investigate the clinical significance and surgical strategies for emergency treatment of thoracolumbar fracture combined with complete spinal cord injury. Methods A retrospective analysis was performed on 56 patients with thoracolumbar fracture accompanied by complete spinal cord injury, but without severe associated injuries to the heart, brain, lung and abdominal organs, who received surgical treatment from January 2006 to December 2012. The injury occurred at L5-8 segment in 1 patient, L6-7 segment in 2, T7-8 in 4, T10-11 in 7, T11-12 in 10, T12-L1 in 18, L1-2 in 9, L2-3 in 3 and T12 in 2. According to the new AO classification system, there were 2 patients with type-A3 injury, 9 type-B2 and 45 type-C. According to the thoracolumbar injury classification and severity score （TLICS）, these patients were scored 4-9 points （mean, 8.0 points）. Frankel neurological classification was all grades A. The patients underwent pedicle screw fixation through a posterior approach within 6 hours after injury （ emergency surgery group, n = 27 ） or 4-7 days after injury （ time-limited surgery group, n = 29）. A comparison between the two groups was made with regard to operation time, intraoperative blood loss, postoperative wound drainage, recovery of neurological functions, postoperative complications, preoperative and postoperative lumbar Cobb angle, anterior edge height of the injured spine, and spaceoccupying lesion in the vertebral canal. Results There was no significant difference in operation time between the two groups. Intraoperative blood loss [ （ 775.7 ± 354. 1 ） ml vs （ 985.3 ± 391. 8 ） ml ] was significantly reduced in time-limited surgery group than in emergency surgery group （ P 〈 0.05 ）. In emergency surgery group swollen limbs （ n = 3 ）, urinary tract infection （ n = 5 ）, and hydronephrosis （ n = 4） were observed. In time-limited surgery group sacroiliac decubital ulcer （ n = 5 ）, swollen limbs （ n = 8）, urinary tract infection （ n = 7） , and h

关 键 词：脊髓损伤 胸椎 腰椎 骨折固定术 

分 类 号：R687.3[医药卫生—骨科学]