Blauth M, Knop C, Bastian L, Krettek C, Lange U
Unfallchirurgische Klinik, Medizinische Hochschule, Hannover.
Orthopade. 1998 Jan;27(1):17-31. doi: 10.1007/PL00003446.
3 different types of complex spinal trauma are defined: Type I means a multilevel contiguous or non contiguous unstable injury, type II is described as a spinal injury with concomitant thoracic or abdominal lesion, type III stands for the coincidence of spinal injury and polytrauma. Overlapping of different types occurs. Type I: The incidence amounts according a german multicenter study to about 2.5%. Multilevel injuries need to be stabilized for a long distance from posterior. With a thorough analysis the segments to be fused are determined. Type II: The leading thoracic injury is a lung contusion which occurs in up to 50% of the cases. A CT scan of the thorax during the first diagnostic screening is recommended. Early reduction and stabilization from posterior should be aimed at. During the first two weeks anterior procedures are contraindicated. Abdominal injuries are to be found in 3-4% of all spinal injuries. All organs could be affected. A typical constallation is the "seat-belt syndrome" with lesions of the upper abdominal organs and a flexiondistraction injury of the upper lumbar spine. The main problem is to make the diagnosis of both components initially. Most of the patients may be treated in one operation by first taking care of the abdominal injury and than stabilizing the spine. The prognosis of this combination is favorable. Type III: In 17-18% of all polytraumatized patients lesions of the spine are to be diagnosed. From these only one third need surgical care. From 680 patients with operatively treated fractures of the thoracolumbar junction 6.2% were polytraumatized according to the multicenter study mentioned above. The risk of missing a spinal injury in polytrauma totals approximately 20%. Surgical stabilization should be performed in the primary phase (day-1-surgery). Additional injuries, potentially time consuming operations with a high blood loss sometimes necessitate a different approach. Non stabilized spinal injuries apparently do not have the same negative effect on the whole organism as long bone fractures. In the early phase of treatment on the C-spine only anterior procedures and on the thoracolumbar spine only posterior techniques should be applied.
定义了3种不同类型的复杂脊柱创伤：I型指多节段连续或不连续的不稳定损伤，II型被描述为伴有胸部或腹部损伤的脊柱损伤，III型代表脊柱损伤与多发伤同时存在。不同类型之间存在重叠。I型：根据一项德国多中心研究，其发生率约为2.5%。多节段损伤需要从后方进行长节段的稳定固定。通过全面分析来确定需要融合的节段。II型：主要的胸部损伤是肺挫伤，发生率高达50%。建议在首次诊断筛查时进行胸部CT扫描。应旨在早期从后方进行复位和固定。在最初两周内禁忌前路手术。在所有脊柱损伤中，腹部损伤的发生率为3% - 4%。所有器官都可能受到影响。一种典型的情况是“安全带综合征”，伴有上腹部器官损伤和上腰椎的屈曲 - 牵张损伤。主要问题是最初要同时诊断这两个部分。大多数患者可以通过一次手术进行治疗，先处理腹部损伤，然后再稳定脊柱。这种联合损伤的预后良好。III型：在所有多发伤患者中，17% - 18%被诊断为脊柱损伤。其中只有三分之一需要手术治疗。根据上述多中心研究，在680例接受手术治疗的胸腰段交界处骨折患者中，6.2%为多发伤。在多发伤中漏诊脊柱损伤的风险总计约为20%。应在急性期（第1天手术）进行手术稳定固定。其他损伤、有时失血量大且耗时的手术可能需要采用不同的方法。未稳定的脊柱损伤对整个机体的负面影响显然与长骨骨折不同。在治疗早期，颈椎仅采用前路手术，胸腰椎仅采用后路技术。
