脊柱复合性损伤分型诊断及治疗

Classification, diagnosis and treatment of complex injuries of the spine

目的 :探讨复合性脊柱损伤的分型、诊断及治疗。方法 :按 Blauth分型方法对 15 7例复合性脊柱损伤进行分型和诊断 ,分析该损伤的特点 ,提出诊断的顺序和避免漏诊的措施。结果 : 型损伤 17例 ( 10 .8% ) , 型损伤 48例 ( 3 0 .6% ) , 型损伤 9 2例 ( 5 8.6% ) ;诊断及救治顺序为先稳定生命体征 ,再抢救重要器官功能 ,然后处理脊柱及四肢骨折 ;脊柱复合性损伤的特点有损伤机制复杂、创伤能量大、对全身影响重、颅脑损伤多及容易漏诊或延迟诊断。结论 :脊柱复合性损伤是一类危重的多发伤 ,正确的分型利于早期诊断 。

Objective: To investigate the diagnosis, classification and treatment of complex injury of the spine. Methods: One hundred and fifty seven patients with complex spinal fractures from 1995 to 1999 were restrospectively reviewed . These injuries were classified and diagnosed according to Blauth's criteria combined with emergency physical examination and radiological finding including plain film, CT and MRI respectively. The characteristic of injury was analyzed; the order of diagnosis, the first aid, and methods avoiding missing diagnosis were discussed. Results: There are 17 cases of typeⅠ (10.8%) , 48 cases of typeⅡ(30.6%) and 92 cases of typeⅢ(58.6%). The order of diagnosis and emergency treatment was: stabilizing life signs, saving the function of vital organs and viscera, and then specific therapy with spinal and limb fractures. The distinctive features of complex spine injury consisted of complicated injury mechanisms, high trauma energy, serious affects to whole body, more craniocerebral damage and leaking out or delayed diagnosis. Conclusion: Complex spine injury is a specific multiple wound with critical condition. Categorizing correctly benefits early diagnosis and early treatment can improves functional recovery obviously.