合并胸部脏器损伤的胸腰椎骨折早期手术疗效分析

摘要

Objective To investigate the clinical effect of early surgery in managing thoracolumbar frac -tures combined with thoracic injuries. Methods Clinical data of 111 patients with thoracolumbar fracture com -bined with thoracic injury were retrospectively analyzed ,who were admitted into our hospital from Mar. 2004 to Oct. 2008. The patients were divided into early surgery group (operation within 72 hours after injury) and delayed surgery group ( operation 72 hours after injury ). Meanwhile, the image data was also collected and statistically ana -lyzed. Results The average hospital stay was 13. 6 ±3.4 in the early surgery group (52 cases) ,while 20. 3 ±4. 3 in the delayed surgery group (76 cases). The averagy hospital stay in the early surgery group was remarkably shor -ter than the delayed surgery group (P <0.05). In the early surgery group , pneumonia occurred in 3 cases after sur-gery(5. 8% ) ,and 8 cases in the delayed surgery group (13. 6% ) ,indicating that the rate of pneumonia in the early surgery group was significantly less than that of the delayed surgery group (P <0. 05). Neurological function analysis showed no remarkable statistical difference. However, when the ISS score was ≥ 25, the postoperative recovery in the early surgery group was better than that of the delayed surgery group (P <0.05 ). And there was no statistical difference in age, operation time, intra-operative blood loss. Conclusion Thoracolumbar fractures combined with chest injury mostly is high-energy injury. This study suggests that early surgical treatment can reduce pulmona -ry complications,shorter hospital stay. Moreover ,for paptients with severe injury (ISS≥25) ,early surgical intervention may help the recovery of neurological function .%目的 探讨早期手术治疗胸腰椎骨折合并胸部脏器损伤的临床疗效.方法 分析2004年3月～2008年10月,我院收治的111例合并胸部脏器损伤的胸腰椎骨折患者的病例资料,根据手术时间分为伤后72h内手术组(早期手术组)及72h后手术组(延期手术组)两组,收集相关临床及影像学资料进行统计分析.结果 早期手术组52例,平均住院(13.6±3.4)d; 延期手术组59例,平均住院日(20.3±4.3)d; 早期手术组平均住院日明显少于延期手术组(P＜0.05).早期手术组术后并发肺炎3例(5.8%),延期手术组术后并发肺炎8例(13.6%),早期手术组肺炎发生率少于延期手术组(P＜0.05); 神经功能恢复(Frankel评分)两组统计学分析无明显差异.行组内神经功能恢复分析,当ISS评分≥25分时早期手术组术后恢复优于延期手术组(P＜0.05).各组在年龄、手术时间、术中出血量上无统计学差异.结论 合并胸部损伤的胸腰椎骨折多为高能量损伤,早期手术治疗有利于减少肺部并发症、缩短住院时间,且严重损伤(ISS≥25分)患者早期手术干预可能更有利于神经功能的恢复.