胸腰椎爆裂性骨折后持续腹胀10例临床诊疗分析
摘要
目的:探讨胸腰椎爆裂性骨折后患者持续腹胀的常见原因和防治措施。方法:选择某军队医院骨科收治的胸腰椎爆裂性骨折后持续腹胀10例,术前及术后均行腹部CT检查,常规给予胃肠减压、肛管排气和缓泻通便等措施,密切监测生命体征变化,每4～6 h复查血常规和电解质,根据病情需要及时行腹部CT检查、超声检查和剖腹探查等。结果:最终确诊为延迟性脾破裂1例(行脾摘除术),延迟性十二指肠破裂1例(行十二指肠修补术),延迟性结肠破裂1例(行结肠修补术),腹膜后血肿1例(行血肿清除术),神经损伤造成的胃肠功能紊乱6例(分别行胃肠减压、肛管排气、缓泻通便及热敷按摩等),均治愈出院。结论:胸腰椎爆裂性骨折后持续腹胀的原因较为复杂,须及时细致查找病因,对迟发性腹部闭合性损伤及时进行处置。
引文
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[27] Oh YM,Choi HY,Eun JP.Delayed Retroperitoneal Hemorrhage due to Lumbar Artery Pseudoaneurysm after Lumbar Posterolateral Fusion[J].J Korean Neurosurg Soc,2013,54(4):344-346.
[28] Ghisi D,Ricci A,Giannone S,et al.Acute pancreatitis after major spine surgery:A case report and literature review[J].Scoliosis Spinal Disord,2018,13:24.
[29] Torba M,Gjata A,Rulli F,et al.Delayed diagnosis and treatment of high grade blunt pancreatic trauma.Case report and review of literature[J].Ann Ital Chir,2017,88:539-545.
[30] Bogner R,Resch H,Mayer M,et al.Rupture of the spleen following thoracoscopic spine surgery in a patient with chronic pancreatitis[J].Eur Spine J,2015,24 Suppl 4:S569-S572.
[2] Agrawal M,Garg M,Kumar A,et al.Management of Pediatric Posttraumatic Thoracolumbar Vertebral Body Burst Fractures by Use of Single-Stage Posterior Transpedicular Approach[J].World Neurosurg,2018,117:e22-e33.
[3] Moon AS,Cignetti CA,Isbell JA,et al.Traumatic hyperextension-distraction injuries of the thoracolumbar spine:A technical note on surgical positioning[J].Eur Spine J,2019,28(5):1113-1120.
[4] Wu Y,Chen CH,Tsuang FY,et al.The stability of long-segment and short-segment fixation for treating severe burst fractures at the thoracolumbar junction in osteoporotic bone:A finite element analysis[J].PloS One,2019,14:e0211676.
[5] Ituarte F,Wiegers NW,Ruppar T,et al.Posterior Thoracolumbar Instrumented Fusion for Burst Fractures:A Meta-analysis[J].Clin Spine Surg,2019,32(2):57-63.
[6] Tinelli M,Topfer F,Kreinest M,et al.Minimally invasive reduction and percutaneous posterior fixation of one-level traumatic thoraco-lumbar and lumbar spine fractures[J].Eur J Orthop Surg Traumatol,2018,28(8):1581-1587.
[7] Meignan P,Lakhal W,Binet A,et al.Compressive chylothorax after lumbar spine fracture[J].Arch Pediatr,2019,26(3):168-170.
[8] Ozdol C,Gediz T,Aghayev K.Cranial and spinal injuries in motorcycle accidents:A hospital-based study[J].Ulus Travma Acil Cerrahi Derg,2019,25(2):167-171.
[9] Benzinger P,Riem S,Bauer J,et al.Risk of institutionalization following fragility fractures in older people[J].Osteoporos Int,2019,doi:10.1007/s00198-019-04922-x.
[10] Chen ZD,Wu J,Yao XT,et al.Comparison of Wiltse's paraspinal approach and open book laminectomy for thoracolumbar burst fractures with greenstick lamina fractures:A randomized controlled trial[J].J Orthop Surg Res,2018,13(1):43.
[11] Craen AM,Lebowitz D,Amico K,et al.Mucinous cystadenoma causing abdominal distension:A case report[J].Cureus,2018,10(11):e3657.
[12] Li C,Wang J,Teng HL,et al.Unilateral Wiltse intermuscular approach and contralateral decompression for the treatment of thoracolumbar burst fracture[J].Zhongguo Gu Shang,2017,30(5):453-457.
[13] Vijayvargiya P,Anderson B,Nehra V.A Rare Cause of Progressive Constipation.Abdominal Distension,and Weight Loss[J].Clin Gastroenterol Hepatol,2018,16(12):e126-e127.
[14] Cao Y,Liu SM.Lactulose for the treatment of Chinese children with chronic constipation:A randomized controlled trial[J].Medicine(Baltimore),2018,97(52):e13794.
[15] Kamber HM,Al-Marzooq TJM,Neamah HR,et al.Outcomes of Operative Management of 96 Cases with Traumatic Retroperitoneal Hematoma:A Single-Institution Experience[J].Open Access Maced J Med Sci,2018,6(11):2128-2132.
[16] Braun U,Trosch L,Sydler T.Ruptured urinary bladder attributable to urethral compression by a haematoma after vertebral fracture in a bull[J].Acta Vet Scand,2014,56(1):17.
[17] Chen CL,Lee CH,Lee TS,et al.Spinal epidural lipomatosis with thoracic osteoporotic compression fracture causing paraplegia[J].J Formos Med Assoc,2003,102(6):429-434.
[18] Ishida Y,McLean SF,Tyroch AH.Cecal bascule after spinal cord injury:A case series report[J].Int Sur Case Rep,2016,22:94-97.
[19] den Braber-Ymker M,Lammens M,van Putten MJ,et al.The enteric nervous system and the musculature of the colon are altered in patients with spina bifida and spinal cord injury[J].Virchows Arch,2017,470(2):175-184.
[20] Park SH,Kim SD,Moon BJ,et al.Short segment percutaneous pedicle screw fixation after direct spinal canal decompression in thoracolumbar burst fractures:An alternative option[J].J Clin Neurosci,2018,53:48-54.
[21] Uchida K,Mizobata Y,Hagawa N,et al.Can we predict delayed undesirable events after blunt injury to the torso visceral organs[J]?Acute Med Surg,2018,5(2):160-165.
[22] Majerus B,Mathonet P,Haxhe JP.Traumatic Rupture of a Duodenal Diverticulum:Case Report and Review of the Literature[J].Acta Chir Belg,2015,115(4):310-313.
[23] Zingg T,Agri F,Bourgeat M,et al.Avoiding delayed diagnosis of significant blunt bowel and mesenteric injuries:Can a scoring tool make the difference A 7-year retrospective cohort study[J]?Injury,2018,49(1):33-41.
[24] Hyun SE,Ko JY,Lee E,et al.The Prognostic Significance of Pedicle Enhancement from Contrast-enhanced MRI for the Further Collapse in Osteoporotic Vertebral Compression Fractures[J].Spine(Phila Pa 1976),2018,43(22):1586-1594.
[25] Goncalves IC,Miguel C,Coelho PC.Colonic acute pseudo-obstruction:Uncommon manifestation of vertebral fracture[J].Acta Reumatol Port,2009,34(4):646-650.
[26] Xie X,Xiang B,Wu Y,et al.Infant progressive colonic stenosis caused by antibiotic-related Clostridium difficile colitis-a case report and literature review[J].BMC Pediatr,2018,18(1):320.
[27] Oh YM,Choi HY,Eun JP.Delayed Retroperitoneal Hemorrhage due to Lumbar Artery Pseudoaneurysm after Lumbar Posterolateral Fusion[J].J Korean Neurosurg Soc,2013,54(4):344-346.
[28] Ghisi D,Ricci A,Giannone S,et al.Acute pancreatitis after major spine surgery:A case report and literature review[J].Scoliosis Spinal Disord,2018,13:24.
[29] Torba M,Gjata A,Rulli F,et al.Delayed diagnosis and treatment of high grade blunt pancreatic trauma.Case report and review of literature[J].Ann Ital Chir,2017,88:539-545.
[30] Bogner R,Resch H,Mayer M,et al.Rupture of the spleen following thoracoscopic spine surgery in a patient with chronic pancreatitis[J].Eur Spine J,2015,24 Suppl 4:S569-S572.