脊柱脊髓损伤伴多发伤的损伤程度评估及治疗结果分析

摘要

Objective To discuss the diagnostic evaluation,treatment and prognosis of multiple trauma complicated with spinal cord injury.Methods 100 cases with acute spinal trauma and spinal cord injury who admitted in our hospital from January 2013 to November 2014 were selected.ISS score and ASIA score were used to the diagnostic evaluation of patients preoperatively.According to the results of the ISS score,the patients were divided into:17-24 points incomplete paraplegia combined with multiple trauma group,25-34 points paraplegia merge more serious multiple trauma group,≥ 35 points paraplegia with severe multiple trauma group.Before and after surgery,the circumstances,the injury site,blood transfusion after admission,surgical site,the days of hospitalization were assessed in the three groups.Results ISS scores increased with the increase of surgical site and the number of injuries.Postoperative ASIA score and ISS-AIS score in three groups were increased compared with preoperation,incomplete paralysis combined with multiple trauma group had statistically significant differences in the number of the injured area,blood transfusion,hospitalization time,the number of surgical site compared with the other groups (P＜0.05).The surgical site,length of stay,the more serious the injury site between paraplegia merge multiple trauma group and paraplegia with severe multiple trauma group,the differences were statistically significant (P＜0.05);paraplegia merge more serious multiple trauma group and paraplegia with severe multiple trauma group had no statistically significant difference in blood transfusion in surgery (P ＞0.05).Conclusion Damage control principle in acute spinal trauma and spinal cord injury has important significance,using the method of preoperative diagnostic evaluation to help you choose and determine the prognosis of the treatment method,while the preoperative evaluation and surgical timing also has important guidance.%目的 探讨并发于多发创伤的脊髓损伤的术前诊断评估及治疗方法及预后影响.方法 纳入我院2013-01-2014-11救治的100例急性脊柱创伤合并脊髓损伤合并脊髓损伤的患者,术前采用ISS评分、ASIA评分标准对患者进行诊断评估,参照ISS评分标准对纳入受试者分组,17-24分的不全截瘫合并多发创伤组,25-34的截瘫合并较严重多发创伤组、截瘫合并严重的多发创伤组的评分≥35,比较三组患者术前术后评估情况、损伤部位、入院后的输血量、手术部位、住院天数等.结果 ISS评分值随着手术部位以及损伤数的增加而升高,术后3组患者ASIA评分以及ISS-AIS评分都较术前提高,但是在受伤部位数、手术输血量、住院时间、手术部位数等指标中不全瘫合并多发伤组与其他组之间具有统计学差异(P＜0.05);手术部位、住院时间、受伤部位截瘫合并较严重多发创伤组以及截瘫合并严重的多发创伤组在差异具有统计学意义(P＜0.05);输血量上截瘫合并较严重与严重的多发创伤组之间比较差异无统计学意义(P＞0.05).结论 损伤控制原则在急性脊柱创伤合并脊髓损伤中具有重要的意义,采用术前诊断评估的方法有助于治疗方法的选择及预后的判定,同时对术前评估和手术时机选择也具有重要的指导意义.