重物砸伤致脊柱骨折的临床特点研究

Clinical characters of spinal fractures resulting from the direct collision by heavy objects

目的分析重物砸伤致脊柱骨折的临床特点,为重物砸伤致脊柱骨折的预防及救治提供参考。方法回顾性分析137例重物砸伤致脊柱骨折患者的临床资料,流行病学方法统计包括性别、年龄、职业、损伤部位、神经损伤、合并伤、ASIA分级、手术情况等。结果137例患者年龄分布主要集中在30~39岁,占33.6%(46/137);所有职业中以工人最多,占45.3%(62/137)。所有患者中颈椎、胸椎、腰椎损伤所占比例依次为32.1%(44/137)、59.1%(81/137)、59.1%(81/137),其中T 12、L 1、L 2、C 6损伤所占比例较大,分别为20.9%(43/206)、19.9%(41/206)、7.8%(16/206)、6.8%(14/206)。57例(41.6%)患者有合并伤,其中合并胸部闭合性损伤最常见(23.4%)。神经损伤发生率在20~<30岁年龄段最高(89.5%),合并伤发生率在40~<50岁年龄段最高(50.0%)。颈椎骨折患者的神经损伤发生率最高(90.9%),胸椎+腰椎骨折合并伤发生率最高(63.6%)。110例患者采用了手术治疗,其中前路手术46例,后路手术64例;术前ASIA分级:A级47例、B级8例、C级14例、D级20例、E级21例,术后2周15例(13.6%)患者有1~2级的神经恢复。结论重物砸伤致脊柱骨折患者神经损伤和合并伤依据年龄和骨折部位有其特别的分布特征,应根据其特点进行防治。

Objective To analyze the clinical characters of spinal fractures resulting from the direct collision by heavy objects in order to provide reference for its prevention and treatment.Methods The clinical data of 137 patients with spinal fractures resulting from the direct collision by heavy objects was analyzed retrospectively,including the gender,age,occupation,traumatic location,nerve injury,concurrent injury,ASIA scales and operation situation.Results Patients at the age from 30 to 40(not including 40)were the main trauma group among all age groups,accounted for 33.6%(46 of 137);and the labors were the main trauma group among all occupations,accounted for 45.3%(62 of 137).Patients with cervical,thoracic,and lumbar trauma were accounted for 32.1%(44 of 137),59.1%(81 of 137),and 59.1%(81 of 137),among which T 12,L 1,L 2,and C 6 spinal traumas were accounted for 20.9%(43 of 206),19.9%(41 of 206),7.8%(16 of 206),6.8%(14 of 206)respectively,which accounted large proportions.Totally 57(41.6%)spinal fracture patients combined with concurrent injuries,among which patients combined with closing thoracic trauma accounted the largest proportion of 23.4%(32 of 137).Patients at the age from 20 to 30(not including 30)had the highest incidence of the nerve injury(89.5%),and those at the age from 40 to 50(not including 50)had the highest incidence of the concurrent injury(50.0%).Cervical fracture patients presented with the highest incidence of the nerve injury(90.9%),thoracic and lumbar fractures patients presented with the highest incidence of the concurrent injury(63.6%).Totally 110 patients treated by operations,with 46 cases of the anterior operation and 64 cases of the posterior operation.American Spinal Injury Association(ASIA)impairment scale was conducted to evaluate the extent of spinal cord injury before operations,which showed 47 cases were grade A,8 cases were grade B,14 cases were grade C,20 cases were grade D and 21 cases were grade E;and 15(13.6%)patients had nerve recovery with ASIA scales improved 1 to 2 grades at 2 weeks after operation.Conclusion The nerve injury and concurrent injuries of patients with the spinal fractures resulting from the direct collision by heavy objects has particular distribution characters on ages and injury location,and the prevention and treatment for this kind of spinal fracture should be designed according to the characters.