Management Of Multiple Injuries Headed By Spinal Cord Injury: A Study Of 55 Cases.

BackgroundWith the development of transportation and architecture,the number of highly energetic injury increases rapidly,among which multiple injuries headed by spinal cord injury is one of the toughest problems characterized by serious traumatic condition,difficult management and bad prognosis.There are many papers talked about the management of multiple injuries headed by head injury,chest injury or limbs fracture,but few papers focused on multiple injuries headed by spinal cord injury and in these papers this kind of injury was always demonstrated as complicated spinal injury or multiple injuries associated spinal injury.Also,the existing classification of the spinal injury do not include such kind of injury,resulting in confusion of treatment protocol about multiple injuries headed by spinal cord injury.So it is necessary to establish a protocol of diganosis and treatment about multiple injuries headed by spinal cord injury.ObjectiveTo establish a protocol about the evaluation,therapy options,operation time,and prognosis judgement of multiple injuries headed by spinal cord injury by reviewing and analyzing materials and follow-up data of numerous cases about multiple injuries headed by spinal cord injury.MethodsFifty-five cases of multiple injuries headed by spinal cord injury treated in our department between Jan.2000 to Nov.2005 were reviewed and analyzed to evaluate their association with Injury Severity Score(ISS) and American Spinal injury Association(ASIA) score.Fifty-five patients were divided into 3 groups in ISS:Group 1(ISS'values from 17 to 24),Group 2(ISS'values from 25 to 34),Group 3(ISS'values above 35).The three groups of injured sites,operation sites,operation bleeding,length of stay,preoperative and postoperative ASIA score were compared. ResultsThe ISS score increases with the number of injured sites and operation sites,resulting in longer stay time.In patients whose ISS score were greater than 25,opeation could be applied as planned safely in the immune observations periods.Totally 55 of 105 patients with multiple injuries headed by spinal cord injury were successfully followed up,and the average follow-up duration was 14 months(6～24 months).There were were 44 male and 11 female patients,and the average age is 37 years (17～58 years).Totally 169 injury sites were included in the ISS-AIS(2005edition) assessment and the average score was 29.3(ranged from18 to 57).The mean preoperative ASIA score was 1.4 and increased to 2.0 postoperatively,which meaned that the therapeutic effect was fine(P＜0.01).Our results showed that the mean ASIA score in the patients of paresis? combined multiple injuries(17≤ISS＜25) increased from 2.2 points preoperatively to 3.1 points at the time of the final follow-up(mean age 36.4 years),while the score in the patients with pamplegia? combined multiple injuries(25≤ISS＜35) increased from 1.7 points to 2.5 points(mean age 38.3 years),and the score in the patients with pamplegia combined severe multiple injuries(ISS≥35) increased from 0.6 points to 0.95 points(mean age 36.0 years).There were no sigficant differences between preoperative and postoperative ASIA score in the patients with paraplegia combined severe multiple injuries(P＞0.05).In patients with paresis combined multiple injuries and pamplegia combined multiple injuries, sigficant differences between preoperative and postoperative ASIA score could be observed (P＜0.01).The operation bleeding,length of stay,the number of injury sites and operation sites in patients with paresis combined multiple injuries were significantly less than that in patients with pamplegia combined multiple injuries(P＜0.05) and patients with paraplegia combined severe multiple injuries(P＜0.05).There were sigficant differences in the length of stay,the incidence rate of the injury site and the number of operation sites between the group of pamplegia combined multiple injuries and the group of paraplegia combined severe multiple injuries(P＜0.05),and no sigficant differences in the operation bleeding between the above-mentioned groups(P＞0.05).Conclusions1.The treatment of multiple injuries headed by spinal cord injury should follow the principle of damage control.2.The ISS assessment,which combined defined anatomical injury sites and quantified standard of injury severity,could be very helpful in the evalution of injury severity,therapy options,judgement of operation time,and prognosis judgement in patients with multiple injuries headed by spinal cord injury.Operation time closely depended on the stablity of general condition and spinal cord injury.3.The complication of acute lung injury in patients with multiple injuries headed by spinal cord injury related to the injury severity and two-hit of affectoi.Damage control was helpful to treat the complications of lung.