合并多发伤的胸腰段及腰椎爆裂骨折的治疗

Treatment for Multiple Traumas with Thoracolumbar and Lumbar Burst Fracture

目的：探讨合并多发伤胸腰段及腰椎爆裂骨折的手术时机和方法。方法：对2007年1月-2012年12月收治合并多发伤胸腰段及腰椎爆裂骨折患者45例回顾分析，脊柱载荷评分均≥7分，依据ISS评分分3组，A组：ISS评分〈16分11例；B组：16分〈ISS≤20分共19例；C组：20分〈ISS≤25分共15例。依据患者的病情，一期行后路AF钉固定，二期前路减压植骨。比较各组间受伤部位数、手术部位个数、手术时间、出血量、住院天数的统计学意义。结果：A组入院后4h内行急诊后路手术治疗，占24％，B组在受伤后3d内接受了手术治疗，占42％，C组在5～7d后一期手术；随着ISS评分的增加，各组间受伤部位数、手术部位个数、确切手术时间、住院天数均增加，各组间比较差异均有统计学意义（P〈0．05）。一期术后8～17d行二期前路减压植骨。所有患者手术均获得成功，随访12～32个月，平均22．6个月，前路植骨均骨性融合。2例神经功能无变化（仍为A级）；其余ASIA评分均提高，与术前比较差异均有统计学意义。结论：多发伤胸腰段腰椎爆裂骨折患者手术时机的选择应建立在对患者全身情况的评估之上，依据ISS评分，合理制定手术时机、手术方案。

Objective： To study suitable surgical times and methods for treating thoracolumbar and lumbar burst fractures in patients with multiple traumas. Methods： A total of 45 cases with multiple traumas suffered from thoracolumbar and lumbar burst fracture undergoing two stages surgery from Jan. 2007 to Feb. 2012 were reviewed retrospectively. The spine load scores of all cases were ≥7. According with Injury Severity Score （ISS）, 45 patients were divided into 3 groups： Group A （ISS scored 16）, Group B （16〈 ISS≤20）, and Group C （20〈 ISS≤25）. The three groups of injured sites, operation sites, operation bleeding, and length of stay, the America spinal injury association （ASIA） scores of preoperative and postoperative were compared. Results：All operations were performed successfully, 11 patients （24%） underwent fracture fixation within 4 hours, 19 patients （42 %） within 72 hours, the remaining patients were related 8 to 17 days. All case had additional anterior decompression and anterior bony graft. With ISS scores improved, the operation bleeding, length of stay, the number of injury sites and operation sites in group A were significant less than group B and group C （P〈0.05）. The ASIA score were significant differences between preoperative and postoperative in patients with paraplegia combined severe multiple injuries （P〈0.05）. All cases were followed up for 12 to 32 months （means 22.6 months）. They were all with satisfactory results in spinal cord decompression and reduction, and achieved bony fusion at 12 months. Conclusion：The operation time and techniques depend on the characteristics of fractures and the general conditions of the patients. The ISS assessment could be very helpful in evaluating of injury severity, therapy options, and judgment of operation time.