交通伤致四肢脊柱骨折的治疗

道路交通伤中四肢脊柱骨折的发生率较高,可由多种致伤机制所致,其中以碰撞最为常见。道路交通伤中的骨折病例呈“离心”分布,多发性骨折、同侧肢体损伤和传导暴力损伤多见。交通伤的急救,首先应处理危及生命的严重合并伤与并发症,在全身情况稳定的情况下,积极处理开放性损伤与骨折。交通伤所致的骨折患者,特别是全身情况差及老年患者,采用外固定器、特别是单侧外固定器治疗是较理想的选择;应用带锁髓内钉治疗长管状骨骨折也取得了较满意的疗效。交通伤所致的骨盆骨折,早期可采用外固定器治疗,同时积极处理骨盆骨折所引起的大出血,对C型骨盆骨折待生命体征稳定后应尽早改用内固定。交通伤所致的脊柱脊髓损伤,钛合金是首选的置入材料,通常颈椎骨折宜采用颈前路钢板螺钉固定融合术,胸腰椎骨折脱位多主张经椎弓根螺钉后路固定术。

Treatment of limb and spine fractures caused by road traffic injuries

Among all the road traffic injuries(RTI ),limb and spine fractures have a very high inci-dence.They can be caused by a variety of traumatogenic mechanisms,of whi ch crash is the most common.The distribution of types of fracture in RTI assumes a centrifugation-like p attern.Multiple fractures,homola teral limb injuries and violence-conducted in juries are common.The priority in RTI emergency is to treat serious concu rrent injuries and life-threatening comp lications.Only after the overall condition of the victim get stabilized can open injuries and fractures be treated ac tively.To treat victims of fracture s caused by RTI,especially those with a poor overall condition or an old age,appl ication of external fixation,espec ially a unilateral one,is a good consider-ation.And application of lockable i ntramedullary nailing to treat long tubular bone fractures has proved ve ry satisfactory.As for pelvis fractur es caused by RTI,external fixation c an be used initially while massive hemor-rhage resulted from the injury shoul d be treated vigorously.Internal fixation should be adopted as soon as th e vital signs get stabilized.To treat spine and spinal cord injuries,titanium a lloy is the first choice for fixation material.In most cases,anterior cervical fix ation and fusion with steel plate and screw is advisable for treatment of f ractures of cervical spine,while posterior i mmobilization with screw through pedicle of vertebra is usually suggested for treatment of fracture-dislocation of thoracolumbar vertebrae.