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腹部中空脏器损伤与脊髓损伤后脊柱及神经感染相关。

Abdominal hollow viscus injuries are associated with spine and neurologic infections after penetrating spinal cord injuries.

作者信息

Schwed Alexander C, Plurad David S, Bricker Scott, Neville Angela, Bongard Fred, Putnam Brant, Kim Dennis Y

机构信息

Division of Trauma/Acute Care Surgery/Surgical Critical Care, Department of Surgery, Harbor-UCLA Medical Center, Torrance, California.

出版信息

Am Surg. 2014 Oct;80(10):966-9.

Abstract

Penetrating spinal cord injuries are rare but potentially devastating injuries that are associated with significant morbidity. The objective of this study was to assess the impact of abdominal hollow viscus injuries (HVIs) on neurologic and spinal infectious complications in patients sustaining penetrating spinal cord injuries. We performed a 13-year retrospective review of a Level I trauma center database. Variables analyzed included demographics, injury patterns and severity, spine operations, and outcomes. Spine and neurologic infections (SNIs) were defined as paraspinal or spinal abscess, osteomyelitis, and meningitis. Multivariate analysis was performed to identify factors associated with SNI. Of 137 patients, there were 126 males (92%) with a mean age of 27 ± 10 years. Eight patients (6%) underwent operative stabilization of their spine. Fifteen patients (11%) developed SNI. There was a higher incidence of SNI among patients with abdominal HVI compared with those without (eight [26%] vs six [6%], P < 0.001). On multivariate analysis, after controlling for injury severity, solid abdominal injury and HVI, vascular injury, and spine operation, abdominal HVIs were independently associated with an increased risk for SNI (odds ratio, 6.88; 95% confidence interval, 2.14 to 22.09; P = 0.001). Further studies are required to determine the optimal management strategy to prevent and successfully treat these infections.

摘要

穿透性脊髓损伤虽罕见,但具有潜在毁灭性,常伴有严重的发病率。本研究的目的是评估腹部中空脏器损伤(HVI)对穿透性脊髓损伤患者神经和脊柱感染并发症的影响。我们对一级创伤中心数据库进行了为期13年的回顾性研究。分析的变量包括人口统计学、损伤模式和严重程度、脊柱手术及预后。脊柱和神经感染(SNI)定义为椎旁或脊髓脓肿、骨髓炎和脑膜炎。进行多变量分析以确定与SNI相关的因素。137例患者中,男性126例(92%),平均年龄27±10岁。8例(6%)患者接受了脊柱手术固定。15例(11%)患者发生了SNI。与无腹部HVI的患者相比,有腹部HVI的患者中SNI的发生率更高(8例[26%]对6例[6%],P<0.001)。多变量分析显示,在控制损伤严重程度、实性腹部损伤和HVI、血管损伤及脊柱手术后,腹部HVI与SNI风险增加独立相关(比值比,6.88;95%置信区间,2.14至22.09;P=0.001)。需要进一步研究以确定预防和成功治疗这些感染的最佳管理策略。

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