Zusammenfassung
Hintergrund
Der Versorgungszeitpunkt von kombiniertem Thorax- und Wirbelsäulentrauma wird kontrovers diskutiert. Um den Einfluss des Versorgungszeitpunktes auf das Outcome und die Lungenfunktion zu überprüfen, untersuchten wir retrospektiv ein schwerverletztes Patientenkollektiv.
Material und Methoden
30 Patienten wurden zwischen 01/00 und 05/03 an frischen Frakturen des BWK 3–LWK 1 von dorsal stabilisiert. Die Einteilung erfolgte in 2 Gruppen: Gruppe I (n=14): Operation nach <72 h; Gruppe II (n=16): Operation nach >72 h. Der Altersdurchschnitt lag bei 39 Jahren. Der ISS für Gruppe I betrug 34, für Gruppe II 41 Punkte.
Ergebnisse
Die Operationszeit betrug in Gruppe I 199 min, in Gruppe II 139 min, der intraoperative Blutverlust in Gruppe I lag bei 600 ml, in Gruppe II bei 425 ml. Der Horowitz-Quotient differierte nicht-signifikant zwischen prä-, intra- und postoperativen Werten. Die Verweildauer der früh versorgten Patienten auf der Intensivstation betrug 16 Tage, signifikant längere Verweildauern zeigten die spät versorgten Patienten mit 24 Tagen. Die Beatmungsdauer betrug in Gruppe I 15, in Gruppe II 19 Tage. Die Gesamtliegezeit der früh versorgten Patienten war mit 63 vs. 108 Tage signifikant verkürzt. Die Gesamtletalität betrug 10%.
Schlussfolgerungen
Auch wenn die retrospektive Analyse einen nicht unerheblichen Bias bei der Auswahl des Versorgungszeitpunktes beinhaltet, scheint die frühe definitive Versorgung von thorakalen/lumbalen Wirbelsäulenverletzungen trotz des begleitenden Thoraxtraumas ohne signifikante perioperative Verschlechterung der Lungenfunktion möglich zu sein.
Abstract
Background
Proper timing of stabilization for spinal injuries is discussed controversially. Whereas early repair of long bone fractures is known to reduce complications, few studies exist that investigate this issue in acute spinal trauma. In particular, the importance of coexisting lung injuries has to be determined, as it might influence clinical course and outcome.
Material and methods
We investigated retrospectively 30 severely injured patients who were stabilized dorsally for fractures of the thoracic and upper lumbar spine. The mean Injury Severity Score (ISS) was 41 points. Patients were divided into two groups: group I: acute trauma/stabilization <72 h and group II: acute trauma/stabilization >72 h. All patients in groups I and II presented radiological or clinical signs of lung contusion.
Results
The average duration of the procedures in group I was 199 min (115–312 min) and in group II 139 min (98–269 min). Intraoperative blood loss and PaO2/FiO2-ratio did not differ significantly between the two groups. The overall in ICU and hospital stay was significantly shorter in group I: 16 days (1–78 days) versus 24 days (7–86 days) in the late group II. Postoperative respirator therapy was necessary in group I for 15 days (0–79 days) and in group II for 19 days (4–31 days). The mortality rate was 10% in this series.
Conclusion
Our data provide further evidence that early stabilization of spinal injuries is safe in severely injured patients, does not impair perioperative lung function, and results in a reduced overall ICU and hospital stay. Further prospective randomized investigations are warranted to prove these results.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Bone LB, Johnson KD, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am 71: 336–340
Chipman JG, Deuser WE, Beilman GJ (2004) Early surgery for thoracolumbar spine injuries decreases complications. J Trauma 56: 52–57
Croce MA, Bee TK, Pritchard E et al. (2001) Does optimal timing for spine fracture fixation exist? Ann Surg 233: 851–858
Greenspan L, McLellan BA, Greig H (1985) Abbreviated Injury Scale and Injury Severity Score: a scoring chart. J Trauma 25: 60–64
Hu R, Mustard CA, Burns C (1996) Epidemiology of incident spinal fracture in a complete population. Spine 21: 492–429
Jaicks RR, Cohn SM, Moller BA (1997) Early fracture fixation may be deleterious after head injury. J Trauma 42: 1–6
Kalb DC, Ney AL, Rodriguez JL et al. (1998) Assessment of the relationship between timing of fixation of the fracture and secondary brain injury in patients with multiple trauma. Surgery 124: 739–745
Kerwin AJ, Griffin MM, Schinco MA et al. (2003) The effect of early spine fixation on mortality. 62. Meeting of the AAST, Minneapolis, pp 243
Kerwin AJ, Frykberg ER, Schinco MA et al. (2005) The effect of early spine fixation on non-neurologic outcome. J Trauma 58: 15–21
McHenry TP, Mirza SK, Wang JJ et al. (2006) Risk factors for respiratory failure following operative stabilization of thoracic and lumbar spine fractures. J Bone Joint Surg Am 88: 997–1005
McLain RF, Benson DR (1999) Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine 24: 1646–1654
Miller PR, Croce MA, Kilgo PD et al. (2002) Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg 68: 845–851
Mirza SK, Krengel WF 3rd, Chapman JR et al. (1999) Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop 359: 104–14
Pape HC, Schmidt RE, Rice J, van Griensven M et al. (2000) Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 28: 3441–3448
Pape HC, van Griensven M, Rice J et al. (2001) Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma 50: 989–1000
Pape HC, Krettek C (2003) Management of fractures in the severely injured influence of the principle of „damage control orthopaedic surgery“. Unfallchirurg 106: 87–96
Rechtine GR 2nd, Smith RM, Cahill D, Chrin AM (1999) Treatment of thoracolumbar trauma: comparison of complications of operative versus nonoperative treatment. J Spinal Disord 12: 406–409
Rosenfeld JF, Vaccaro AR, Albert TJ et al. (1998) The benefits of early decompression in cervical spinal cord injury. Am J Orthop 27: 23–28
Sapkas GS, Papagelopoulos PJ, Papadakis SA et al. (2003) Thoracic spinal injuries: operative treatments and neurologic outcomes. Am J Orthop 32: 85–88
Schinkel C, Greiner-Perth R, Schwienhorst-Pawlowsky G et al. (2006) Der Einfluss des Versorgungszeitpunktes von Frakturen der Brustwirbelsäule auf die perioperative respiratorische Funktion. Orthopäde 35: 331–336
Schlegel J, Bayley J, Yuan H, Fredricksen B (1996) Timing of surgical decompression and fixation of acute spinal fractures. J Orthop Trauma 10: 323–330
Stocker R, Neff T, Stein S et al. (1997) Prone postioning and low-volume pressure-limited ventilation improve survival in patients with severe ARDS. Chest 111: 1008–1017
van Os JP, Roumen RM, Schoots FJ et al. (1994) Is early osteosynthesis safe in multiple trauma patients with severe thoracic trauma and pulmonary contusion? J Trauma 36: 495–498
Waydhas C, Nast-Kolb D, Trupka A et al. (1996) Posttraumatic inflammatory responce, secondary operations and late mutiple organ failure. J Trauma 40: 624–631
Interessenkonflikt
Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Frangen, T., Ruppert, S., Muhr, G. et al. Respiratorische Insuffizienz nach Brustwirbelfrakturen. Orthopäde 36, 365–371 (2007). https://doi.org/10.1007/s00132-007-1049-8
Issue Date:
DOI: https://doi.org/10.1007/s00132-007-1049-8