Petitjean M E, Mousselard H, Pointillart V, Lassie P, Senegas J, Dabadie P
Emergency Department, Le Tripode Hospital, Bordeaux, France.
J Trauma. 1995 Aug;39(2):368-72. doi: 10.1097/00005373-199508000-00030.
The relative benefits of conservative or surgical treatment in thoracic spinal trauma are still controversial. Owing to its anatomic relations, thoracic spinal trauma is specific regarding neurologic prognosis, the high incidence of associated injuries, and surgical management. Over a 30-month period, 49 patients sustained thoracic spinal trauma with neurologic impairment. The authors review population characteristics, associated injuries, and surgical management, and underline the high incidence of associated injuries, in particular, blunt chest trauma. In their opinion, early spinal decompression has no indication in complete paraplegia. Concerning partial paraplegia, early surgery may enhance neurologic recovery. Nevertheless, they suggest three main criteria in deciding whether or not to perform surgery early: the existence of residual spinal compression, the degree of neurologic impairment, and the presence of potential hemorrhagic lesions or blunt chest trauma, especially pulmonary contusion.
保守治疗或手术治疗在胸椎创伤中的相对益处仍存在争议。由于其解剖关系，胸椎创伤在神经学预后、合并伤的高发生率以及手术管理方面具有特殊性。在30个月的时间里，49例患者发生了伴有神经功能障碍的胸椎创伤。作者回顾了患者的人口统计学特征、合并伤和手术管理情况，并强调了合并伤的高发生率，尤其是钝性胸部创伤。他们认为，早期脊髓减压不适用于完全性截瘫。对于不完全性截瘫，早期手术可能会促进神经功能恢复。然而，他们提出了决定是否早期进行手术的三个主要标准：是否存在残余脊髓压迫、神经功能障碍的程度以及是否存在潜在的出血性病变或钝性胸部创伤，尤其是肺挫伤。
