脊柱脊髓锐器伤合并异物存留救治.docVIP

脊柱脊髓锐器伤合并异物存留救治 　 作者：李青　王春庆　刘钢　肖正亮　邓进　李昆 【摘要】 　　［目的］探讨脊柱脊髓锐器伤合并异物存留的诊疗特点及预后。［方法］回顾了1995年1月～2005年11月本科收治的128例脊柱脊髓锐器伤的临床资料，对其中19例合并有异物存留患者的诊治、术后恢复情况进行分析总结。［结果］19例均行急诊手术清创，术后死亡1例(5.3％)，椎管内感染1例，发生脑脊液漏1例。14例合并有脊髓损伤患者中，13例术后经综合康复治疗脊髓损害程度ASIA评分较手术前提高(Plt;0.05)。［结论］脊柱脊髓锐器伤合并异物存留时需在充分地术前准备下急诊手术治疗，必要的术前检查，制定详细的手术计划是提高抢救成功率的关键。 【关键词】 脊柱骨折　脊髓损伤 异物 外科手术 　　Management of spine and spinal cord stab injury with foreign bodies retained in wound:report of 19 cases∥ 　　Abstract：［Objective］To investigate the clinical characteristics,treatment and prognosis of spine and spinal cord stab injury with foreign bodies retained in wound.［Method］In a group of 128 cases of spine and spinal cord stab injury that admitted to our department from January 1995 to November 2005,19 had foreign bodies retained in wound.The result of 19 cases were analyzed retrospectively.［Result］Operations such as scrutinization of the spinal canal,clean-up of the hematoma,extraction of foreign bodies were performed according to different conditions for 19 cases of spine and spinal cord stab injury with foreign bodies retained in wound of 19 patients,one(5.3%) died,two happened cerebrospinal fluid leakage,one meningomyelitis and wound infection was observed.Of 14 cases with neurological injury,scores of ASIA scales of 13 patients increased after comprehensive rehabilitation treatment(Plt;0.05).［Conclusion］Emergency operations for the patients of spine and spinal cord stab injury with foreign bodies retained in wound are necessary after enough preparations.In order to improve the successful rate of trauma resuscitation,it is important to make a completely preoperative plan and necessarily preoperative laboratory investigation. 　　Key words：spinal fracture; spinal cord injury; foreign body; surgical procedure 　　脊柱脊髓锐器伤合并异物存留临床上少见，其损伤特点、治疗方法及预后均与闭合性损伤不同，以往文献资料对脊柱脊髓锐器伤合并异物存留的描述很少，本院自1995年1月～2005年11月，共收治128例脊柱脊髓锐器伤，本研究对其中19例合并有异物存留患者的诊治情况进行分析总结。 　　1 临床资料与方法 　　1.1 资料来源 　　选择1995年1月～2005年11月贵阳医学院附属医院住院的脊柱脊髓锐器伤患者128例，符合下列