脊柱骨折截瘫合并膈肌损伤的诊治探讨

A study of diagnosis and treatment of spinal fracture-paraplegia combined with diaphragmatic injury

目的 探讨脊柱骨折截瘫合并膈肌损伤的机制和救治原则。方法 对近 2 0年来本院收治的脊柱骨折截瘫合并膈肌损伤的 16例患者进行回顾性分析。结果 本组患者受伤原因分为直接暴力或间接暴力。颈椎骨折截瘫合并膈肌损伤 6例 ,胸椎骨折截瘫合并膈肌损伤 2例 ,胸腰椎骨折截瘫合并膈肌损伤 8例。非手术治疗 6例 ,死亡 6例 ;手术治疗 10例 ,死亡 4例 ,好转 6例。总病死率 6 2 5 % ,好转率 37 5 %。结论 脊柱骨折截瘫合并膈肌损伤是骨科最为严重的创伤之一 ,膈肌损伤不易发现。首先应急诊修复膈肌及胸腹部脏器损伤 ,对颈椎骨折同时手术处理截瘫 ;对胸椎及腰椎骨折 。

Objective To study the mechanism and treatment principle of spinal fracture paraplegia combined with diaphragmatic injury. Methods A retrospective analysis was made of 16 patients with spinal fracture paraplegia combined with diaphragmatic injury,who were admitted and received emergency treatment at our hospital in the past 20 years.Results The injuries were caused by direct or indirect violence.Six sustained cervical spinal fracture paraplegia combined with diaphragmatic injury,two men had thoracic vertebra fracture paraplegia combined with diaphragmatic injury and 8 cases had frature paraplegia of thoracolumbar region combined with diaphragmatic injury.Six patients received non surgical treatment,but died finally.10 received surgical treatment,of them 4 died and 6 improved.The total mortality rate was 62 5% and improvement rate was 37 5%.Conclusion Spinal fracture paraplegia combined with diaphragmatic injury is one of the most severe trauma in orthopedics.It is easy to detect paraplegia in the patients clinically,while diaphragmatic injury is often neglected and missed.Diaphragmatic muscle should first be repaired and at the same time chest and abdomen carefully examined.In fracture of cervical vertebra paraplegia,treatment may follow operation of the neck.While in patients with thoracic and lumbar vertebra fracture,diaphragmatic injury should first be dealt with,then fracture of spinal columm. [Key words] Fracture of spinal column;Paraplegia;Diaphragmatic injuryow dose of interleukin 1β(IL 1β) pretreatment can enhance the myocardium resist ance to ischemia and reperfusion(I/R) injury during the late phase We measured the changes of heat shock protein72(HSP72), IL 1β and superoxide dismutase(SOD) of the myocardium ,determined the infarct size and recorded the change of heart function and the rate of reperfusional arrhythmia at the end of ischemia 1h and reperfuse 2h after immediately,12h and 24h after IL 1β injected rats There was a significant increase of left ventricular diastolic pressure(LVDP) and a significant decrease of ±dp/dt and SOD contents in the ILPC and I/R groups than in the control at 0～24h after IL 1β or NS pretreat,but the increased amplitude of LVDP and decreased amplitude of the ±dp/dt and SOD were significantly lower in the ILPC group than in the I/R group at the end of 24h after IL 1βpretreatment( P <0 05) At the same time,the expressions of HSP72 increased and IL 1β decreased significantly ,the infarct size reduced remarkably in the ILPC group than in the control and I/R groups ,and the rate of ventricular arrhythmia was obviously reduced in the ILPC group than in the I/R group( P <0 05) No difference was observed in the ILPC and I/R groups at immediately and 12 hours It suggested that low dose IL 1β pretreatment induced the late cardioprotective and its mechanism could be associated with increase of protective proteins and the balance of oxidants and antioxidants