创伤性血胸合并胸椎爆裂骨折的救治体会

The treatment experiences of the traumatic hemothorax plus burst fracture of thoracic spine

目的探讨创伤性血胸合并胸椎爆裂骨折救治体会,提高创伤所致的血胸合并胸椎爆裂骨折的认识及处理能力。方法回顾性分析解放军第175医院2014年6月至2016年5月收治的36例创伤性血胸合并胸椎爆裂骨折患者的临床资料。36例患者中男22例,女14例,年龄42.6(18~52)岁。胸椎骨折的分布:单个节段1例,2个节段8例,3个节段17例,4个节段6例,5个节段4例。采取急诊科、骨科、胸心外科、康复医学科联合救治模式:4例失血性休克失代偿期患者生命体征不稳定,急诊即予抗休克治疗;32例接受手术治疗。结果 36例中,4例因失血性休克经积极抗休克等综合救治血压仍不稳定,出现"致死三联征"(低体温、代谢性酸中毒、凝血功能障碍)死亡;3例术后2~3周因全身多器官功能衰竭死亡;29例成功救治,术后恢复良好。脊柱Frankel分级:术前A级14例中术后恢复至B级4例、C级2例、无明显改善5例、死亡3例;B级8例中恢复至C级3例、D级1例、无明显改善2例、死亡2例;C级8例中恢复至D级5例、无明显改善3例;D级6例中恢复至E级4例、死亡2例。成功救治的29例经康复治疗后26例可坐立、3例可下床活动。结论创伤性血胸合并胸椎爆裂骨折是一种复杂的多发伤,采取多学科联合救治的快速康复医学模式,完善院内早期救治平台,预防损伤所致的不可逆性病理损害,早期抗休克、手术及康复治疗是抢救生命、改善生活质量的关键所在。

Objective To investigate the treatment of the traumatic hemothorax plus burst fracture of thoracic spine and improve the understanding and capability of dealing with it. Methods From June 2014 to May 2016 in our hospital, the clinical materials of 36 cases of the traumatic hemothorax plus fracture of thoracic spine were analyzed retrospectively. The patients （22 males and 14 females） were aged 42.6 years （between 18 and 52 years）. The distribution of thoracic vertebrae fractures： 1 case of single segment, 8 cases of 2 segments, 17 cases of 3 segments, 6 cases of 4 segments and 4 cases of 5 segments. 32 patients underwent surgical treatment. Results The blood pressure of 4 cases was still unstable through first aid due to hemorrhagic shock, and the lethal triad still appeared after antishock treatment. Three patients died due to systemic multiple organ failure 2-3 weeks after surgery, 29 cases. The Frankel classification： There were 14 cases of A level pre-operation then recovered to 4 cases of B level, 2 cases of C level,5 cases remained no recovery sign post-operation and 3 cases died; There were 8 cases of B level pre-operation then recovered to 3 cases of C level, 1 cases of D level,2 cases remained no recovery sign post-operation and 2 cases died; There were 8 cases of C level pre-opera- tion then recovered to 5 cases of D level and 3 cases remained no recovery sign post-operation; There were 6 cases of D level pre-opera- tion then recovered to 4 cases of E level post-operation and 2 cases died. 26 patients could sit and stand after rehabilitation treatment, and 3 patients could do off-bed activities. Conclusion Traumatic hemothorax plus burst fracture of thoracic spine is a complex multiple injuries, early anti-shock, surgery and rehabilitation treatment is to save lives, improve the quality of life of the key.