腰脊髓损伤伴严重多发伤的外科治疗

目的:探讨腰脊髓损伤为主严重多发伤的救治方法。方法:回顾性分析42例以腰脊髓损伤为主严重多发伤患者的临床资料,创伤严重度(ISS评分)为20～57分,平均(34.60±3.57)分。平均受伤部位约3处。脊髓损伤节段L1-L5,其中单节段损伤29例,2节段以上损伤13例。脊髓损伤(按ASIA分级):A级8例,B级7例,C级12例,D级15例。均采用椎管减压、植骨内固定术重建脊柱稳定性。结果:所有患者获得随访,时间6个月～4年,平均1年4个月,腰背痛症状均明显缓解,生活可自理,无内固定断裂及松动,植骨均融合。随访时脊髓损伤(按ASIA分级):A级5例,B级4例,C级6例,E级27例。27例神经症状完全恢复,8例有1级以上恢复,7例无变化。结论:腰脊髓损伤为主严重多发伤急诊应遵循伤害控制原则,尽早采取手术治疗重建脊柱稳定性,恢复神经功能,减少残疾。

Surgical therapy of lumbar spinal cord injury combined with severe polytraumatism

Objective:To explore the strategy of clinic treatment of lumbar spinal cord injury combined with severe polytraumatism.Methods:A retrospective analysis was performed to 42 patients with lumbar spinal cord injury and severe polytraumatism.Among the patients,the ISS score was from 20 to 57 points with the mean of(34.60±3.57) points;the place of injury was from 5 to 20 places with the mean of 3 places;the segment of injury was from L1 to L5.There were 29 patients with single segment of spinal cord injury and 13 patients with more than two segments of spinal cord injury.According to ASIA(american spinal injury association) grading system,there were 8 patients in grade A,7 in grade B,12 in grade C,15 in grade D.All patients were treated with decompression and internal fixation with bone graft.Results:All patients were followed up for 6 to 48 months with an average of 16 months.The lumbodorsal pain relieved obviously with self-care lifestyle and bone fusion,without fixation breaking or loosening.According to ASIA grading system,27 got complete recovery,8 improvement of more than one grade,and 7 no improvement.There were 5 cases in A,4 in B,6 in C and 27 in E in the patients.Conclusion:The strategy of harm control should be abided for emergency treatment of lumbar spinal cord injury combined with severe polytraumatism.The early operation may re-establish spinal stability,restore nerve function and reduce deformity.