胸腰段骨折早期手术及延期手术的比较

Comparative study of early and late surgery for thoracolumbar spine fractures

目的了解胸腰段骨折的手术时机对并发症、住院时间、重症监护时间、神经功能恢复的影响。方法胸腰段骨折患者共72例,按损伤严重度评分(injury severity score,ISS)分为低ISS组(ISS<16)和高ISS组(ISS≥16),并按早期(损伤后<72 h)和延期(损伤后≥72 h)行手术治疗,比较术后并发症、住院时间、重症监护时间、神经功能恢复情况。结果低ISS组中,早期手术的患者住院时间较短(P<0.05)。高ISS组中早期手术的患者急性呼吸窘迫综合征发生率、住院时间、重症监护时间显著降低(P<0.05),总的并发症发生率也降低(P<0.05)。随访时患者的神经功能恢复早期手术与延期手术间差异无统计学意义(P>0.05)。结论胸腰段骨折尤其是严重损伤的患者,早期行手术治疗能减少术后并发症,缩短住院时间、重症监护时间。

Objective To investigate whether early spinal stabilization in thoracolumbar spine fractures could decrease complications, lengths of stay in hospital and ICU, and improve neurological outcome. Methods A total of 72 patients with thoracolumbar spine fractures were divided into 2 groups on the basis of injury severity score（ISS）. Postoperative complications, hospital and intensive care unit lengths of stay, improvement of neurological outcome were compared between groups who had early （ 〈 72 h from injury） versus late （ ≥72 h from injury） surgical repair. Results In low ISS groups, patients who received early surgery had shorter hospitalization. Meanwhile, early surgery patients had significantly shorter hospital and intensive care unit lengths of stay, lower acute respiratory distress syndrome（ARDS） and overall complication rate（ P 〈 0.05 ） in high ISS groups. There was no difference in neurological outcome between early and late stabilized spinal fractures （P 〉 0.05）. Conclusion Compared with late repair of thoracolumbar fractures, early repair is preferential to patients with serious injury, because of fewer associated postoperative complications, shorter hospital and intensive care unit lengths of stay.