Schinkel Christian, Frangen Thomas M, Kmetic Andrej, Andress Hans-Joachim, Muhr Gert
Berufsgenossenschaftliche Kliniken Bergmannsheil, Department of Surgery, Ruhr University, Bochum, Germany.
J Trauma. 2006 Jul;61(1):156-60; discussion 160. doi: 10.1097/01.ta.0000222669.09582.ec.
Optimal timing of stabilization for thoracic spine injuries in multiply injured patients is still controversial because additional lung injury occurs frequently. Early operation might benefit clinical course and outcome in these patients.
We analyzed the German National Trauma Database (n = 8,057) and compared clinical parameters and outcome of patients with severe thoracic spine injuries (Abbreviated Injury Scale >2; n = 298) who underwent spine stabilization within 72 hours posttrauma (group I) or later (group II).
In all, 95% of all patients had additional severe thoracic injuries such as lung contusion. In spite of comparable demographic data, patients in group I had a significant shorter intensive care unit (ICU) stay (median [range]: group I, 8 [0-237] days; group II, 16 [2-91] days; p = 0.001), shorter dependence on mechanical ventilation (group I: 2 [0-48] days; group II: 5 [0-91] days; p = 0.02), and shorter hospital stay (group I: 22 [1-255] days; group II: 31 [2-274] days; p = 0.048). Expected mortality calculated by Trauma and Injury Severity Score was significantly reduced in group I (calculated: 16%; documented: 6%; p < 0.05) but not in group II (19% versus 17%; p = NS).
Almost 10% of all patients in the German National Trauma Registry had severe spine injuries. Severe thoracic injuries occurred in 95% of these patients with thoracic spine trauma. We provide further evidence that early stabilization of thoracic spine injuries in trauma patients reduces overall hospital and ICU stay and improves outcome. Thus early stabilization of thoracic spine injuries within 3 days after trauma appears to be favorable.
多发伤患者胸椎损伤的最佳固定时机仍存在争议，因为常发生额外的肺损伤。早期手术可能对这些患者的临床病程和预后有益。
我们分析了德国国家创伤数据库（n = 8,057），比较了创伤后72小时内（I组）或之后（II组）接受脊柱固定的严重胸椎损伤患者（简明损伤定级>2；n = 298）的临床参数和预后。
总体而言，95%的患者有其他严重的胸部损伤，如肺挫伤。尽管人口统计学数据相似，但I组患者的重症监护病房（ICU）住院时间显著缩短（中位数[范围]：I组，8[0 - 237]天；II组，16[2 - 91]天；p = 0.001），机械通气依赖时间缩短（I组：2[0 - 48]天；II组：5[0 - 91]天；p = 0.02），住院时间缩短（I组：22[1 - 255]天；II组：31[2 - 274]天；p = 0.048）。根据创伤和损伤严重度评分计算的预期死亡率在I组显著降低（计算值：16%；记录值：6%；p < 0.05），但在II组未降低（19%对17%；p = 无显著性差异）。
德国国家创伤登记处近10%的患者有严重脊柱损伤。这些胸椎创伤患者中95%发生了严重胸部损伤。我们提供了进一步的证据表明，创伤患者早期固定胸椎损伤可减少总体住院和ICU住院时间并改善预后。因此，创伤后3天内早期固定胸椎损伤似乎是有利的。
