脊柱脊髓伤合并其它脏器损伤142例的治疗体会

Study and Treament of spine and Spinal Cord Trauma Complicated by Thoracoabdominal Viscera Injury about 142 cases

目的探讨颈段和胸腰段脊柱脊髓伤合并其它脏器损伤的急诊处理方法。方法回顾性分析我院15年来收治颈部、胸部及腰部脊髓伤合并其它脏器损伤142例,其中颈椎骨折(C3-C7)25例,胸椎骨折(T4-T12)46例,腰椎骨折(C1-C4)71例,合并颅脑损伤20例,胸部损伤32例,腹部损伤22例,骨盆损伤20例,四肢骨折或脱位48例。结果随访神经功能康复情况,本组生存138例,121例获得随访,时间为4个月至5年,平均2.8年,神经功能恢复情况按Frankel标准:A级50例中部分感觉恢复16例,其余神经功能均比术前改善1级-3级,双上肢麻木6例,慢性腰脊痛12例,脊柱后凸畸形6例,4例死于多器官功能衰竭综合征(MODS)。结论及时准确的诊断治疗是成功与否的关键,对颈段、胸段骨折合并脊髓伤同时合并有头部、胸部,腹部脏器以及四肢骨盆骨折、脱位的患者应全面仔细地体格检查,结合X线CT以及MRI检查,优先处理危及生命的头部、胸腹部伤,纠正休克,同时避免加重脊柱脊髓损伤,这也是危重病人急诊治疗时常采用的有效方法 。

[Objective] To study and treatment of diagnosis troracolumbar spine and spinal cord trauma complicated by thoracoabdominal Viscera injury.[Methods] A retrospective study was performed on 142 cases with thoracolumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injuries treated in our unit late fifteen years,of which there were 25 cases with cervical fracture（C3-C7）,46 cases with thoracic vertebra fracture（T4-T12）,71 cases with lumbar fracture（L1-L4）,20 cases with injury of cranium,32 cases with complicated chest injury,22 cases with abdominal injury,20 cases pelvis injury,48 Cases with extremities fracture or dislocation.[Results] Followed-up frankel standard nerve function recovery.138 cases survived,with 121 cases were followed-up period form 4 months to 5 years.Average 2.8years,According to frankel standard nerve function recovery showed that among 50 cases at grade A,16 cases had partial or sensation recovery and the other got nerve function improvement for grade 1-3,of which 12 cases had chronic low-back pain,six acolisis,four cases were died of postoperative MODS.[Conclusions] Prompt diagmsis and proper treatment were the key of the success.Thoraco-lumbar spine and spinal cord trauma complicated by thoracoabdominal viscera injuries treated cervical fracture thoracic vertebra fracture case with injury of craniumabdominal injury,extremities fracture or dislocation.examination including X-ray,CT or MRI is necessary.Treating shock and try to avoid aggravation of spine and spinal cord injury,It was effective procedures frequently used in the emergency treatment of the severe pelvic fracture patients.