高处坠落伤患者相关因素与预后的关系

背景高处坠落伤是当今致伤、致残、致死的主要原因之一,但目前国内有关其相关因素的研究的报道较少.目的探讨高处坠落伤各相关因素对伤情的影响,客观、准确地判别不同致伤条件下的损伤类型及伤情程度,提高高处坠落伤诊断与救治水平.设计以诊断为依据进行回顾性分析.单位解放军广州军区武汉总医院骨科.对象1990-01/2002-12解放军广州军区武汉总医院收治的825例高处坠落伤患者,男645例,女180例,年龄1～85岁.方法根据病案纪录,对825例高处坠落伤患者就其相关因素进行回顾性分析,全部病例运用创伤改良评分法(RISS)进行评价.主要观察指标着重观察分析不同坠落高度、不同着地姿势、不同年龄及体质量、不同地面性质的致伤规律、伤情特点及损伤严重度.结果损伤类型、伤情程度、救治效果及转归情况与上述因素密切相关.3m以下坠落的患者以四肢与颅脑伤为主,随着落差增大,脊柱、骨盆骨折发生比率增加,8m以上坠落者,胸腹腔内脏器损伤明显增多.最易损伤的部位是最先着地的部位,其中头着地伤情最重,死亡率最高,足着地引起的连锁性损伤较多.儿童以头部损伤常见,成人脊柱、肋骨、骨盆、下肢、胸内脏器及连锁性损伤多于儿童.相同高度坠落时,成人重于儿童,坠落于水泥、石质等坚硬地面重于坠落于松软的泥地.结论不同条件下坠落,其损伤情况、致伤规律、伤情特点明显不同.坠落高度、着地姿势是决定损伤类型及伤情程度的主要因素,年龄与体质量、地面性质对伤情有重要影响.上述因素对高处坠落伤的诊治及预后有重要意义.

Correlation between related factors and prognosis of the patients with high falling injury

BACKGROUND: The high falling injury is one of the main causes for the occurrence of the injury, disabilities and death, while at present there are few reports about its related factors in China.OBJECTIVE: To study the effects of the correlated factors on the high falling injury, distinguish the pattern and degree of the injury on different injury conditions objectively and correctly, and improve the level of the diagnosis and treatment for the high falling injury.DESIGN: A retrospective analysis based on the diagnosis.SETTING: Department of Orthopaedics, Wuhan General Hospital of Guangzhou Military Command.PARTICIPANTS: Totally 825 patients of the high falling injury were chosen from Wuhan General Hospital of Guangzhou Military Command from January 1990 to December 2002. There were 645 males and 180 females whose age varied from 1 to 85 years old.METHODS: According to the case recording, the retrospective analysis about the correlated factors was done in the 825 cases of the high falling injury, and the rivised injury severity score(RISS) was applied to the evaluation of all the cases.MAIN OUTCOME MEASURES: Focus on the regularities, characteristics and degrees of the injury at different falling heights, landing positions, ages and body mass and the ground circumstances.RESULTS: The injury pattern, degree, the effect on the treatment and the crisis had close relationship with the factors above. When the falling height was less than 3 m, the injuries mainly occurred on the limbs and craniocerebrum, and as the falling height increased the occurrence rate of the fracture of the spinal column and pelvis also increased. When the falling height was above 8 m, the injuries of the intrapleural and intraperitoneal organs significantly increased. The most easily injured positions were the first landing positions, in which the head landing was the most severe and had the highest mortalities, the foot landing caused more linkage injuries. There were common head injuries in children, and the injuries of the spinal column, ribs,pelvis, lower limbs, intrapleural organs and the linkage injuries in the adults were more than in children. At the same falling height, the injuries of the adults are severer than that of the children. The injuries on the hard ground like cement and stones were severer than those on the loose mud ground.CONCLUSION: The injury states, regularities and characteristics vary with different conditions. The falling height and landing position are the main factors to determine the injury pattern and degree. The age and body mass and the ground circumstance have important effects on the injury. The above factors have important significance for the diagnosis, treatment and prognosis of the high falling injury.