地震伤所致脊柱骨折的治疗方法选择
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摘要
[目的]探讨TLICS评分(thoracolumbar injury classification and severity)在地震伤所致脊柱骨折应用。[方法]汶川地震中解放军总医院汶川抗震救灾医疗队在成都军区总医院和成都空军医院共收治95例脊柱骨折患者,其中男49例,女46例,记录骨折患者一般资料、受伤机制、骨折特点,并根据患者TLICS评分采用不同的治疗方法。[结果]95例脊柱骨折患者共有107个椎体受累,其中76例患者被倒塌房屋砸伤,19例患者跳楼所致坠落伤。85个椎体(79.5%)骨折位于胸腰段(T11~L1),36例患者TLICS评分大于4分,15例患者评分等于4分,44例患者评分小于4分。40例患者采用切开手术治疗,8例患者采用椎体成形术,47例患者采用保守治疗。[结论]地震所致脊柱骨折可以采用TLICS评分,据此采用不同的治疗方法。
[Objective]To investigate the application of thoracolumbar injury classification and severity thoracolumbar injuty chassification and severityscdre(TLICS)score in spinal fracture caused by earthquake.[Method]Night-five patients with spinal fractures were treated in Chendu Army General Hospital and Chendu Air Force Hosptial by Wenchuan earthquake medical team from Chinese PLA General Hospital.There were 49 males and 46 females with mean age of 48.6 years.The general patient data,injury mechanism,and injury time were recorded.The different treatments were decided by the TLICS score.[Result]There were 107 vertebral fractures in the 95 patients,out of whom 76 patients were injured by building collapsed,and the other 19 by falling from buildings.TLICS score was more than 4 in 36 patients,4 points in 15 patients,less than 4 points in 44 patients.40 patients were treated with open operation,15 patients with vertebraplasty,and the other patients with conservative treatment.[Conclusion]The earthquake spinal fractures can be treated with different treatments based on the different TLICS scores.
[Objective]To investigate the application of thoracolumbar injury classification and severity thoracolumbar injuty chassification and severityscdre(TLICS)score in spinal fracture caused by earthquake.[Method]Night-five patients with spinal fractures were treated in Chendu Army General Hospital and Chendu Air Force Hosptial by Wenchuan earthquake medical team from Chinese PLA General Hospital.There were 49 males and 46 females with mean age of 48.6 years.The general patient data,injury mechanism,and injury time were recorded.The different treatments were decided by the TLICS score.[Result]There were 107 vertebral fractures in the 95 patients,out of whom 76 patients were injured by building collapsed,and the other 19 by falling from buildings.TLICS score was more than 4 in 36 patients,4 points in 15 patients,less than 4 points in 44 patients.40 patients were treated with open operation,15 patients with vertebraplasty,and the other patients with conservative treatment.[Conclusion]The earthquake spinal fractures can be treated with different treatments based on the different TLICS scores.
引文
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[5]Stone R.Wenchuan earthquake.Scientists race against the clock to gauge landslide risk[J].Science,2008,5882:1408.
[6]高伟兴,李晓强,马琳,等.唐山地震脊髓损伤并发尿路感染患者流行病学调查[J].中华创伤杂志,2007,4:253-256.
[7]胥少汀,刘树清.脊柱脊髓损伤的过去与现在:唐山大地震后的30年回顾[J].中华骨科杂志,2007,7:547-550.
[8]Dai LY,Jiang SD,Wang XY,et al.A review of the management of thoracolumbar burst fractures[J].Surgical Neurology,2007,67:221-231.
[9]Lee JY,Vaccaro AR,Lim MR,et al.Thoracolumbar injury classifica-tion and severity score:a new paradigm for the treatment of thoraco-lumbar spine trauma[J].J Orthop Sci,2005,10:671-675.
[10]Roer N,Lange E,Bakker F,et al.Management of traumatic thoraco-lumbar fractures:a systematic review of the literature[J].Eur Spine J,2005,14:527-534.
[11]Bono CM,Vaccaro,AR,Hurlbert RJ,et al.Validating a newly pro-posed classification systemfor thoracolumbar spine trauma:looking to the future of the thoracolumbar injury classification and severity score[J].J Orthop Trauma,2006,20:567-572.
[12]Vaccaro AR,Zeiller SC,RJ,et al.The thoracolumbar injury severity score a proposed treatment algorithm[J].J Spinal Disord Tech,2005,18:209-215.
[13]Patel AA,Vaccaro AR,Albert TJ,et al.The adoption of a newclassi-fication system time-dependent variation in interobserver reliability of the thoracolumbar injury severity score classification system[J].Spine,2007,3:105-110.
[14]Vaccaro AR,Baron EM,Sanfilippo J,et al.Reliability of a novel clas-sification system for thoracolumbar injuries:the thoracolumbar injury severity score[J].Spine,2006,11:62-69.
[15]卢世璧.汶川地震伤员救治的几点经验[J].中国矫形外科杂志,2008,20:1521-1522.
[2]Chang CM,Lee LC,Connor KM,et al.Modification effects of coping on post-traumatic morbidity among earthquake rescuers[J].Psychia-try Research,2008,158:164-171.
[3]Rathore FA,Farooq F,Muzammil S,et al.Spinal cord injury manage-ment and rehabilitation:highlights and shortcomings from the2005earthquake in Pakistan[J].Arch Phys Med Rehabil,2008,89:579-585.
[4]Vaccaro AR,Lehman RA,Hurlbert J,et al.A new classification of thoracolumbar injuries:the importance of injury morphology,the in-tegrity of the posterior ligamentous complex,and neurologic status[J].Spine,2005,20:2325-2333.
[5]Stone R.Wenchuan earthquake.Scientists race against the clock to gauge landslide risk[J].Science,2008,5882:1408.
[6]高伟兴,李晓强,马琳,等.唐山地震脊髓损伤并发尿路感染患者流行病学调查[J].中华创伤杂志,2007,4:253-256.
[7]胥少汀,刘树清.脊柱脊髓损伤的过去与现在:唐山大地震后的30年回顾[J].中华骨科杂志,2007,7:547-550.
[8]Dai LY,Jiang SD,Wang XY,et al.A review of the management of thoracolumbar burst fractures[J].Surgical Neurology,2007,67:221-231.
[9]Lee JY,Vaccaro AR,Lim MR,et al.Thoracolumbar injury classifica-tion and severity score:a new paradigm for the treatment of thoraco-lumbar spine trauma[J].J Orthop Sci,2005,10:671-675.
[10]Roer N,Lange E,Bakker F,et al.Management of traumatic thoraco-lumbar fractures:a systematic review of the literature[J].Eur Spine J,2005,14:527-534.
[11]Bono CM,Vaccaro,AR,Hurlbert RJ,et al.Validating a newly pro-posed classification systemfor thoracolumbar spine trauma:looking to the future of the thoracolumbar injury classification and severity score[J].J Orthop Trauma,2006,20:567-572.
[12]Vaccaro AR,Zeiller SC,RJ,et al.The thoracolumbar injury severity score a proposed treatment algorithm[J].J Spinal Disord Tech,2005,18:209-215.
[13]Patel AA,Vaccaro AR,Albert TJ,et al.The adoption of a newclassi-fication system time-dependent variation in interobserver reliability of the thoracolumbar injury severity score classification system[J].Spine,2007,3:105-110.
[14]Vaccaro AR,Baron EM,Sanfilippo J,et al.Reliability of a novel clas-sification system for thoracolumbar injuries:the thoracolumbar injury severity score[J].Spine,2006,11:62-69.
[15]卢世璧.汶川地震伤员救治的几点经验[J].中国矫形外科杂志,2008,20:1521-1522.
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