回顾性分析汶川地震脊柱损伤患者诊治特点

An retrospective analysis of the characteristics of spinal injury patients in Wenchuan earthquake

目的回顾总结地震中脊柱损伤患者的临床特征及治疗效果,为该类损伤的预防和救治选择提供依据。方法对我院2008年5月12日～6月15日收治的281例地震脊柱骨折伤员的临床资料进行分析,其中男性126例,女性155例;年龄7～86岁,平均(46.32±12.47)岁。合并其他部位创伤的有223例。246例无手术指征伤员均在病情平稳后转运至院外及省外。35例在我院经手术治疗并获随访21～28个月,平均29.4个月。其中男性24例,女性11例;年龄17～76岁,平均38.2岁。通过影像学检查比较其手术前后受伤椎体前后缘高度变化、椎管截面积改善情况,依据Frankel分级标准评估手术前后及随访期间神经功能变化情况。结果中老年人群、女性、农民和室内活动均是脊柱伤的高危因素。受伤的原因以重物砸压、坠落最为常见。脊柱骨折的部位集中在T11～L2,并有较多多节段脊柱骨折。随访患者术后神经功能恢复Frankel分级2级及以上为54%,l级为38%,术后总的恢复率为91%。结论分析总结地震灾害中的受伤机制及损伤特点,有助于对伤员及时准确地诊治,减少脊柱损伤的漏诊误诊。早期的减压、固定可解除对脊髓的压迫、增加脊柱的稳定性,为脊髓的功能恢复创造有利条件。

Objective To summarize the clinical characteristics and treatment effects of the spinal injury patients in earthquake, and to provide the basis for the prevention and management of this type of injury. Methods The clinical data of 281 spinal injury cases in the earthquake were analyzed. There were 126 males and 155 females ; their age ranged from 7-86 years ,with an average of （ 46.32 ＋ 12.47） years. A total of 223 patients were found trauma on the other body sites, 246 patients without surgical indications were transferred into other hospitals after their physical conditions became stable. Totally 35 patients were followed up for 21-28 months, averaging 29.4 months,including 24 males and 11 females ;their age ranged from 17-76 years, averaging 38.2 years. Totally 35 patients who got surgical treatment in our hospital were followed up. The variation of front and rear edges of the height and spinal canal crosssectional area improvement before and after surgery were analyzed by imaging. Improvement of nerve function before and after surgery were assessed according to the Frankel grading standards. Results The older age,women, farmers and indoor activities were risk factors for spinal injury. Heavy-weight crushing and falling were the most common causes. The most common sites of spinal fractures were Tn-L2, and mostly multi-segmental spinal fractures. Frankel grade recovery of nerve function in patients with follow-up indicated level of two and above 54% and one level 38%. Conclusion Analyzing the earthquake disaster in the injury mechanism and injury characteristics can help to make timely and accurate diagnosis ,reduce misdiagnosis for spinal injuries. Early decompression and fixation can relieve pressure on the spinal cord, increase the spinal stability and create favorable conditions for spinal cord function recovery.