Dai Li-Yang, Yao Wei-Fang, Cui Yi-Min, Zhou Qing
Department of Orthopaedic Surgery, Xinhua Hospital, Shang-hai Second Medical University, Shanghai, China.
J Trauma. 2004 Feb;56(2):348-55. doi: 10.1097/01.TA.0000035089.51187.43.
The initial evaluation and treatment of patients with multiple injuries are challenging. However, little is known about thoracolumbar fractures in patients with multiple injuries. We aimed to determine the incidence of missed injuries of the thoracolumbar spine in patients with multiple injuries, to examine the reasons for the delay in diagnosis, and to study the selection of treatment options in the management and timing of surgical intervention.
One hundred forty-seven consecutive patients with acute thoracolumbar fractures and multiple trauma at the authors' hospital between 1988 and 1997 were retrospectively reviewed. The incidence of missed injuries of the thoracolumbar spine and the reasons for the delay in diagnosis were determined. All these patients were observed for a minimum of 3 years after surgery, except four who died during their hospital stay.
Delayed diagnosis of thoracolumbar fractures was made in 28 patients (19%). There was an increased incidence of pulmonary complications (p < 0.01) and increased length of hospital stay (p < 0.05) in patients treated nonoperatively compared with patients treated operatively. Although no significant differences in the recovery rate of neurologic function (p > 0.05) were noted between the groups, the surgical patients had highly significantly less pain compared with the nonoperative patients (p < 0.01). The relationship between the timing of thoracolumbar surgery and complications failed to show statistical significance (p > 0.05). Neither the severity of injury nor the timing of surgery had any significant effect on the recovery rate (p > 0.05).
Patients with blunt trauma caused by high-energy impact injuries are much more likely to have thoracolumbar fractures even if injuries elsewhere have been noted. Further radiographic studies of the thoracolumbar spine should be performed if there is any question related to a thorough and systematic examination. Choice of treatment options of thoracolumbar fractures in patients with multiple injuries is not different from that in patients with no associated injuries to other systems. Appropriate timing of thoracolumbar fracture fixation in patients with multiple injuries should not be dependent on a rigid protocol.
对多发伤患者进行初始评估和治疗具有挑战性。然而，对于多发伤患者的胸腰椎骨折了解甚少。我们旨在确定多发伤患者胸腰椎漏诊损伤的发生率，探讨诊断延迟的原因，并研究手术干预的时机及治疗方案的选择。
回顾性分析1988年至1997年间在作者所在医院连续收治的147例急性胸腰椎骨折合并多发伤患者。确定胸腰椎漏诊损伤的发生率及诊断延迟的原因。除4例住院期间死亡的患者外，所有这些患者术后至少观察3年。
28例患者（19%）胸腰椎骨折诊断延迟。与手术治疗的患者相比，非手术治疗的患者肺部并发症发生率增加（p < 0.01），住院时间延长（p < 0.05）。尽管两组间神经功能恢复率无显著差异（p > 0.05），但手术患者的疼痛程度明显低于非手术患者（p < 0.01）。胸腰椎手术时机与并发症之间的关系未显示出统计学意义（p > 0.05）。损伤严重程度和手术时机对恢复率均无显著影响（p > 0.05）。
即使已发现其他部位有损伤，高能冲击伤导致的钝性创伤患者仍更有可能发生胸腰椎骨折。如果对全面系统检查存在任何疑问，应进一步对胸腰椎进行影像学检查。多发伤患者胸腰椎骨折治疗方案的选择与无其他系统相关损伤的患者并无不同。多发伤患者胸腰椎骨折固定的合适时机不应依赖于严格的方案。
