乘坐快艇引发脊柱骨折原因分析及防治总结—附32例临床报道

Cause Analysis and Prevention Summary of Spinal Fracture Caused by Speedboat——32 Cases Report

目的 探讨乘坐快艇引发脊柱骨折的受伤机制及诊断要点,总结诊疗经验,减少误诊漏诊率,并采取综合预防干预措施,从而降低该类事件发生率。方法 回顾2011年7月至2018年6月,收治因东南亚旅游乘船所致脊柱骨折病例共32例,记录该组患者人口学特点、受伤原因、伤后至就诊时间,受伤责任节段及骨密度情况。记录诊治方法,治疗方法选择上,非手术治疗6例,经后路切开钉棒系统复位植骨内固定术8例,经后路经皮钉棒复位固定6例,经皮椎体成形术11例,钉棒复位固定结合责任椎强化术1例,合并骨质疏松症患者均予抗骨质疏松治疗,出院后1、3、6、12月随访。结果 该组患者男性11例,女性21例,年龄:48.4±14.6岁(19~65岁),年龄段小于50岁13人,50岁以上19人。其中3例骨量减少,12例骨质疏松。受伤至就诊时间6.6±4.5 d(1~24 d),受伤原因上下船时摔倒致伤3例,快艇上走动摔倒致伤7例,因颠簸致伤22例。其中骶尾椎骨折4例,下腰椎骨折(L_(3)-L_(5))5例,胸腰段骨折(T_(11)-L_(2))25例,其余节段1例(T_(8)),其中4例患者出现多节段椎体骨折。该组病例治疗顺利,无感染及神经损伤及其他严重并发症发生,椎体成形术患者4例出现骨水泥渗漏,为非椎管内渗漏,无任何临床症状。所有患者均随访至少12月,未出现伤椎骨不愈。1例出现相邻椎体再骨折,1例12月复查时经皮椎弓根螺钉出现断钉,取出内固定,断钉留于体内,无特殊不适。结论 乘坐快艇出海因颠簸容易造成脊柱骨折,应谨慎选择出行工具,老年人尤其是骨密度降低的人群不建议乘坐快艇出行,一旦伤后出现剧烈疼痛及时就医,或者及时回国正规医院就诊,在未确诊之前减少不必要的负重,避免不合理的搬运造成二次损伤。

Objective To explore the injury mechanism and diagnosis points of spine fracture caused by speedboat,summarize the experience of diagnosis and treatment,and adopt comprehensive preventive measures to reduce the incidence of such events.Method Retrospective analysis from July 2011 to June 2018,a total of 32cases of spinal fractures caused by speedboat from Southeast Asia which treated in our department.The demographic characteristics,causes of injury,time from injury to treatment,responsible segments of injury and bone mineral density were recorded.In this group of cases,6 cases underwent conservative treatment,8 cases underwent posterior open reduction with screw rod system,bone graft and internal fixation,6 cases underwent posterior percutaneous screw rod reduction and fixation,11 cases underwent percutaneous vertebroplasty,and 1 case underwent screw rod reduction and fixation combined with vertebroplasty.Among them,patients with osteoporosis were treated with anti osteoporosis treatment,and the patients were followed up 1,3,6 and 12 months after discharge.Result The age over 50 years in females and that of 60 years in male were 15 cases,46.9%of the total,3 of them had reduced bone mass and 12 had osteoporosis.The average time from injury to medical treatment was 6.6±4.5 days(1~24days),among them,10 cases were caused by falls and 22 cases were injured by bumps.Satisfactory results were in this group of patients,without infection and nerve damage and other serious complications,4 cases of vertebroplasty appeared non-spinal canal cement leakage,without any clinical symptoms.All patients were followed for at least 12months without vertebrae nonunion,1 case had an adjacent vertebral body fracture,and 1 case had a broken nail in the percutaneous pedicle screw during the 12-month fellow-up.The internal fixture was removed and the broken nail was left in the body without special discomfort.Conclusion The elderly,especially those with low bone mineral density,are likely to suffer from spinal fracture due to turbulence when they take a speedboat,so they should choose transport carefully.In case of severe pain after injury,It is necessary to see a doctor in time or return to a regular hospital and reduce unnecessary load before diagnosis and avoid secondary injury caused by unreasonable handling.