多发伤患者胸腰椎骨折的手术时机  

Timing of surgery for thoracolumbar fractures in patients with multiple traumas

作　　者：戴力扬[1] 蒋雷生[1] 沈雷[1] 周青[1] 张家红[1] 姚维芳[1] 王伟[1] 倪斌斌[1] 沈云[1] 

机构地区：[1]上海第二医科大学附属新华医院骨科,上海市200092

出　　处：《中华创伤骨科杂志》2004年第1期84-87,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨多发伤患者胸腰椎骨折的手术时机。方法对91例多发伤患者的胸腰椎骨折手术治疗资料作回顾性分析,本组91例,其中男59例,女32例。年龄17～64岁,平均34.8岁。骨折按Denis分类计压缩性骨折7例,爆裂性骨折66例,屈曲分离损伤3例,骨折脱位15例。入院时ISS评分为13～66分,平均31.8分。ASIA评分0～89分,平均26.2分。随访时间3～12年。结果有42例在伤后3d内行手术治疗,占45.1%,其中仅21例(23.1%)在受伤后24h内接受了手术治疗。其余患者手术时间为伤后4～15d,其中有15例(16.5%)为1周以后行手术治疗。胸腰椎骨折手术治疗时机与ISS评分呈负相关(P<0.01),但与ASIA评分相关性无显著统计学意义(P>0.05),并发症发生率与手术时机无显著相关性(P>0.05)。ISS评分及手术时机对ASIA评分恢复率均无显著影响。结论多发伤患者胸腰椎骨折手术时机的选择应建立在对患者全身情况的评估以及手术治疗利弊的权衡基础之上,而不应作机械的界定。Objective To investigate the optimal timing of surgical inte rvention for thoracolumbar fractures in patients with multiple traumas. Methods A total of 91 patients, 59 males and 32 females, with multiple traumas were retr ospectively reviewed for the long-term results of surgery for thoracolumbar fra ctures.Their age ranged 17 to 64 (average, 34.8) years old. There were 7 patient s with compression fractures, 66 patients with burst fractures, 3 with flexion- distraction injuries, and 15 fracture-dislocations, as defined by Denis classif ication system. The average ISS (Injury Severity Score) and ASIA (American Spina l Injury Association) motor score of these patients on admission was 31.8 (range , 13-66)and 26.2 (range, 0-89), respectively. They were followed up for 3 to 1 2 years. Results Forty-one (45.1%) of the patients underwent fracture fixation within the first 72 hours, of whom only 21 patients (23.1%) were treated opera tively within the first 24 hours. The remaining patients were stabilized at vari ous time intervals. Fifteen patients (16.5%) underwent immobilization surgery d elayed for more than 7 days. The timing of surgery was negatively related to ISS score (P< 0.01), but not associated with ASIA score (P >0.05). Neither the seve rity of injury nor the timing of surgery had any significant effect upon the rec overy rate (P >0.05). The relationship between the timing of thoracolumbar surge ry and incidence of complications failed to show statistical significance (P >0. 05). Conclusion Appropriate timing of surgery for thoracolumbar fractures in pat ients with multiple traumas should be dependent upon a clear understanding and c omprehensive analysis of the patients systemic status and the risks and benef its of surgical intervention rather than a rigid protocol.

关 键 词：手术时机 胸腰椎骨折 多发伤 手术适应证 功能锻炼 

分 类 号：R687.3[医药卫生—骨科学]