脊髓损伤为主的全身多发伤相关因素研究

Analysis of the Associated Factors of Spinal Cord Injuries with Multi-traumas

目的 分析因不同原因所致创伤性脊髓损伤合并其他多器官损伤的特点 ,了解以脊髓损伤为主的全身多发伤的受伤模式和相关因素 ,总结此类损伤的处理要点。方法 回顾性总结了 1996年 8月至 2 0 0 2年 7月间收治的 132例包含脊髓损伤的全身多发伤的临床资料 ,分析伤者的年龄分布 ,受伤原因 ,合并伤情况 ,脊髓损伤的主要节段和程度 ,处理方式 ,以及临床后果。结果 本组 132例伤者中 ,男性 94例 ,女性 38例。年龄 14～ 6 5岁 ,以青壮年为主。最主要的致伤原因是车祸 ,占 6 2 % ,其次为坠落伤 ,占 2 4 .5 %。最常见的合并伤是四肢创伤 (约5 1.5 % ) ,其次为头伤 (约 32 % )和胸伤 (约 30 % )。脊髓损伤的主要节段发生在 C1 - 2 ,C6 - T1 ,T6 - T8和 T1 2 - L1 。合并伤越重 ,后果越差 ,本组共死亡 34例 (约为 2 6 % ) ,主要死因是呼吸系统并发症导致呼吸衰竭和重型颅脑损伤。完全性脊髓损伤者神经功能无明显恢复 ,不完全脊髓损伤者中有 4 1例 (约 5 4 % )经治疗后按 ASIA标准可恢复 级以上。结论 合并伤对创伤性脊髓损伤的治疗和预后都有重要的影响 ,了解以脊髓损伤为主的全身多发伤的受伤模式和临床后果有助于早期判断和处理这类复杂的多发创伤 。

Objective To investigate the patterns of spinal cord injuries with multi-traumas and clinical outcomes. Methods A retrospective review was performed on 132 patients with spinal cord injuries associated with multiple injuries that were treated at our department from August 1996 to July 2002. The age at presentation, causes of injury, associated injuries, the locations and degrees of spinal cord injuries, treatment, and clinical outcome were determined. The American Spinal Injury Association (ASIA) Grades were adopted in this study. Results Among all patients, 94 were males and 38 were females, the ages ranged from 14 to 65 years, most of them were youth. Traffic accidents were the most mechanism causing injuries (62%), followed by fall (24.5%). Traumas on extremities constituted the first associate injuries (51.5%), head injuries constituted 32%, and thoracic injuries (30%). The main damaged regions of spinal cord were C 1-2, C 6-T 1, T 6-8, and T 12-L 1. The more serious the associated injuries, the poorer the outcome. Thirty four (26%) patients died finally. The major causes of death were respiratory failure and severe brain injuries. The neurologic defects improved partially in patients with incomplete spinal cord injuries while no obvious signs showed improvement in patients with complete spinal cord injuries. Conclusion The complexity of associated injuries will affect the treatment and prognosis of traumatic spinal cord injuries importantly. To understand the patterns and characteristics of this kind of multiple traumas is helpful to evaluating and treating these complicated injuries, and also may be helpful to the design of safety furniture and devices.