多发伤患者胸腰椎骨折的治疗选择  

Management decisions for thoracolumbar spine fractures in patients with multiple injuries

作　　者：戴力扬[1] 沈雷[1] 崔一民[1] 王伟[1] 

机构地区：[1]上海第二医科大学附属新华医院骨科,上海200092

出　　处：《临床骨科杂志》2003年第2期124-127,共4页Journal of Clinical Orthopaedics

摘　　要：目的　探讨多发伤患者胸腰椎骨折的治疗选择。方法　对多发伤合并胸腰椎骨折患者 ,非手术治疗 5 2例 ,手术治疗 91例。随访时间 3～ 12年。结果　非手术组与手术组的年龄、ISS评分差异无显著性 (P >0 0 5 )。非手术组的肺部并发症发生率高于手术组 (P <0 0 1) ,住院时间也长于手术组 (P <0 0 5 ) ,但深静脉血栓形成、褥疮及尿路感染发生率两组之间差异无显著性 (P >0 0 5 )。手术组ASIA评分低于非手术组 (P <0 0 5 ) ,后凸畸形程度也更为严重 (P <0 0 1) ,但ASIA评分与后凸畸形程度之间并无相关性 (P >0 0 5 )。最后随访时两组患者ASIA评分恢复率差异无显著性 (P >0 0 5 ) ,虽然两组患者的后凸畸形均得到纠正 (P <0 0 1) ,患者的功能评定结果差异无显著性 (P >0 0 5 ) ,但手术患者的后凸畸形程度及疼痛程度较非手术患者轻 (P <0 0 5、P <0 0 0 1)。结论　多发伤中胸腰椎骨折的治疗选择与未合并其他系统及部位损伤的骨折患者并无根本区别。稳定性压缩骨折行非手术治疗多可取得满意疗效 ,当椎体压缩程度超过 5 0 %时则可考虑手术治疗 ,而爆裂性骨折、屈曲分离损伤和骨折脱位均属于手术治疗的适应证。Objective To study the treatment options of thoracolumbar fractures in multiple injured patients. Methods 147 consecutive patients with acute thoracolumbar fractures and multiple trauma were reviewed retrospectively. All patients except 4 who died during their hospital stay were treated nonoperatively (52 cases) or operatively (91 cases). These patients were followed up for 3～12 (average, 5 2) years. Results The nonsurgical and surgical groups were similar with regard to age, ISS score at presentation ( P> 0 05). There was an increased incidence of pulmonary complications ( P< 0 01) and increased length of hospital days ( P< 0 05) in patients treated nonoperatively compared with patients treated operatively; but there were no significant differences of deep venous thrombosis, pressure sore, and urinary tract infection was noted between nonsurgical and surgical patients ( P> 0 05). At initial presentation, the patients who underwent surgical intervention had more severe neurologic deficit as defined as ASIA score ( P< 0 05) and more kyphotic deformity ( P< 0 01), although no relationship was found between ASIA score and degree of kyphotic deformity ( P> 0 05). At the final follow up, there were no significant differences ( P> 0 05) between the groups when the recovery rate of the ASIA score was compared; but the surgical patients had significantly less kyphotic deformity ( P< 0 05) than that of the nonsurgical patients, although the kyphotic deformity in both of the two groups had been highly significantly corrected ( P< 0 01) when compared with the initial sagittal alignment. With regard to the work and function status and pain level, the surgical patients had similar functional results to the nonsurgical patients ( P> 0 05) but highly significantly less pain compared to the nonoperative patients ( P< 0 01). Conclusion Treatment choice of thoracolumbar fractures in patients with multiple injuries is not different from that in patients with no associated injuries to othe

关 键 词：多处创伤 脊柱骨折 

分 类 号：R683[医药卫生—骨科学]