胸腰段脊柱脊髓伤合并胸腹脏器伤的诊断和治疗  

Diagnosis and treatment in thoracolumbar spine and spinal cord injuries patients combined with thoracoabdominal injuries

作　　者：梁惠明[1] 叶志伟[1] 

机构地区：[1]中山大学附属第三医院急诊科,广东广州510000

出　　处：《中国当代医药》2016年第12期26-29,共4页China Modern Medicine

摘　　要：目的探讨胸腰段脊柱脊髓伤合并胸腹脏器伤不同诊断方法的效果及治疗结局,以期为临床研究提供可参考依据。方法选取2010年1月~2012年1月入住我院胸腰段脊柱脊髓损伤的患者120例,其中46例合并胸腹脏器损伤定为并发组,另74例未合并胸腹脏器损伤定为未并发组。未并发组采用脊柱外固定器联合经皮椎体内植骨术治疗38例,后路经椎弓根内固定术结合椎体成形术治疗27例,后路经椎弓根内固定术治疗9例;并发组采用脊柱外固定器联合经皮椎体内植骨术治疗16例,后路经椎弓根内固定术结合椎体成形术治疗23例,后路经椎弓根内固定术治疗7例。观察两组患者手术情况、住院时间、B超与CT诊断情况、手术对神经功能的影响及预后情况。结果并发组中死亡2例,合并脾破裂及血气胸患者各1例,其余手术均顺利完成;未并发组无死亡病例。并发组手术时间、术中出血量及住院时间均高于未并发组（均P〈0.05）;以手术结果为＂金标准＂,B超诊断符合率为71.74%低于CT诊断符合率95.65%（P〈0.05）;并发组末次随访感觉及运动神经功能评分均高于术前（P〈0.05）,与未并发组同期同指标对比,差异无统计学意义;未并发组优秀率95.95%高于并发组72.73%（P〈0.05）。结论对于胸腰段脊柱脊髓伤患者,应采取多种检查方法共同诊断,以减少误诊、漏诊的发生,治疗中要优先处理危及生命的胸腹脏器损伤,无论是否合并脏器损伤,经不同脊柱固定治疗,对患者远期运动、感觉神经影响不明显。Objective To discuss effectiveness of different diagnostic methods diagnosis and treatment outcome of thoracolumbar spine and spinal cord injury combined with thoracoabdominal injury,in order to provide reference for clinical research. Methods 120 cases from January 2010 to January 2012 admitted to our hospital thoracolumbar spine and spinal cord injuries patients combined with thoracoabdominal injuries were selected,of which 46 cases with thoracoabdominal injury were set as concurrent group,the other 74 cases of unconsolidated thoracoabdominal injury as nonconcurrent group.38 cases were treated by spinal external fixation apparatus combined with percutaneous vertebral body bone graft surgery,posterior transpedicular internal fixation combined with vertebral plasty in the treatment of 27 cases,and posterior vertebral arch fixation in treatment of 9 cases in nonconcurrent group.Spinal external fixation apparatus combined with percutaneous vertebral body bone graft surgery was used in the treatment of 16 cases,posterior transpedicular internal fixation combined with vertebral plasty in the treatment of 23 cases,and posterior transpedicular internal fixation surgery in the treatment of 7 cases in concurrent group.The operation,hospitalization time,diagnosis of B ultrasound and CT fault,the influence of surgery on neural function and prognosis of two groups were observed. Results Unless 2 cases died（of which 1 cases splenic rupture and 1 case hemopneumothorax）,operations on other cases were completed smoothly in concurrent group;nobody died in nonconcurrent group.Operation time,intraoperative bleeding and hospitalization time in concurrent group were higher than those in nonconcurrent group（all P0.05）;Operation results were the gold standard,diagnostic accordance rate of B ultrasound was 71.74% lower than that of CT（95.65%）（P0.05）;Sensory and motor nerve function score in concurrent group at the end of follow-up were higher than those before operation（P0.05）;Compared with the same index in conconc

关 键 词：胸腰段 脊柱脊髓伤 胸腹脏器伤 诊断 手术治疗 

分 类 号：R6[医药卫生—外科学]