合并多发伤的胸腰段脊柱脊髓火器伤的临床特征和救治探讨

Clinical features and therapeutic measures of thoracic and lumbar spinal firearm wounds with neurologic deficit complicated with multiple injuries

目的 探讨合并多发伤的胸腰段脊柱脊髓火器伤的临床特点和救治经验,提高其诊治水平。方法 回顾性分析了12例合并多发伤的胸腰段脊柱脊髓火器伤的损伤特点和救治情况。本组中椎管贯通伤3例,椎管盲管伤5例,椎管切线伤3例,椎体伤1例。12例均合并胸、腹腔脏器的损伤。治疗包括早期伤道清创术,正确处理多发伤,及时的脊髓减压、内固定等。结果 术后椎体前缘高度、矢状面指数和椎管矢状径均明显改善,术后随访与术后相比差异无显著性意义。按美国脊髓损伤协会的ASIA分级标准,术后11例分别提高了1～3级,1例A级无变化。术后无1例发生椎体高度丢失、再移位、内固定失败等并发症。结论 认识合并多发伤的胸腰段脊柱脊髓火器伤的临床特征,掌握正确的早期处理原则,摘除椎管内异物,解除脊髓压迫,重建脊柱稳定性,是提高救治水平的关键。

Objective To investigate clinical features and therapeutic rules for thoracic and lumbar spinal firearm wounds with neurologic deficit complicated with multiple injuries,and to improve the diagnosis and treatment level.Methods We retrospectively analyzed the injury characteristics and methods of treatment in 12 patients with spinal firearm wounds.Among all of the cases there were 3 cases of penetrating wounds on spinal canal,5 cases of blind tract wounds,3 cases of tangential wounds,and 1 case of vertebral body injury.All the cases were complicated with injuries of abdominal organs.Results After débridement and properly dealing with multiple injuries in the early stage,spinal cord decompression and internal fixation were applied promptly.Postoperative and preoperative anterior vertebral body height,sagittal index and sagittal diameter,were significantly different.The data between the postoperative and follow-up were not significantly different.According to American Spinal Injury Association(ASIA),the spinal cord function were improved in 11 patients by 1-3 grades.One case of grade A was unchanged.There were no lose of vertebral body height,redisplacement,and fixation failures after operation.Conclusion It is very important to recognize and master clinical features of thoracic and lumbar spinal firearm wounds,properly handle the early principle,remove foreign bodies inside spinal canal to relief spinal compression and reconstruct spinal stability,which is very helpful for improving cure standards.