Erden ERTÜRER, Mehmet TEZER, İRFAN ÖZTÜRK, Ünal KUZGUN

Erişkinlerdeki vertebra kırıklarının ve eşlik eden yaralanmaların değerlendirilmesi

Amaç: Acil servise travma etyolojisiyle başvuran erişkinlerde hasta profilinin belirlenmesi için vertebra kırıkları ve eşlik eden yaralanmalar değerlendirildi. Çalışma planı: Çalışmada, 1988-2003 yılları arasında vertebra kırığı nedeniyle tedavi edilen 372 hasta (264 erkek, 108 kadın; ort. yaş 30.4; dağılım 18-65) demografik özellikler, travma mekanizması, eşlik eden yaralanmalar, kırık seviyesi ve tipi ile tedavi şekli açısından incelendi. Kırık tipleri Denis sınıflamasına göre sınıflandırıldı. Sonuçlar: Denis sınıflamasına göre, 212 hastada (%57.0) kompresyon kırığı, 146’sında (%39.3) burst kırığı, sekizinde (%2.2) bel tipi emniyet kemeri kırığı, altısında da (%1.6) kırıklı çıkık saptandı. Olguların 290’ında (%77.9) tek seviyede, 61’inde (%16.4) iki seviyede, 15’inde (%4.0) üç seviyede, altısında da (%1.6) dört seviyede vertebra kırığı vardı. En sık yaralanmanın torakolomber bileşke bölgesinde (275 kırık, %57.2) olduğu görüldü. Kırık nedeni, 211 olguda yüksekten düşme (%56.7), 145 olguda trafik kazası (%39.0), 16 olguda (%4.3) direkt travma idi. Yüz on olguda (%29.6) başka bölgelerde kırık görüldü; en sık rastlananı kalkaneus kırığıydı (35 hasta, %9.4). Ortopedik sorunların dışında 38 olguda (%10.2) diğer organ yaranması ve/veya kafa travması vardı. Hastaların 302’sinde (%81.2) konservatif tedavi, 70’inde (%18.8) cerrahi tedavi uygulanmıştı. Çıkarımlar: Yüksek enerjili travma sonrasında acil servise başvuran her hastaya vertebra kırığı varmış gibi davranılmalıdır. Vertebra kırığı saptanan olgular başka seviyede kırık ve eşlik edebilecek diğer yaralanmalar açısından ayrıntılı olarak incelenmelidir.

Anahtar Kelimeler:

Omurga kırıkları, Torasik omurga, Lumbar omurga, Yaralar ve yaralanmalar

Evaluation of vertebral fractures and associated injuries in adults

Objectives: We evaluated vertebra fractures and associated injuries in adults to determine the profile of patients presenting with a trauma etiology. Methods: The study included 372 patients (264 men, 108 women; mean age 30.4 years; range 18 to 65 years) who were treated for vertebra fractures from 1988 to 2003. Evaluations included demographic features of patients, trauma mechanisms, fracture levels and types, treatment modalities, and associated injuries. The types of fractures were assessed according to the Denis classification. Results: The types of fractures were classified as follows: compression fractures (n=212, 57.0%), burst fractures (n=146, 39.3%), seat belt-induced fractures (n=8, 2.2%), and fracture-dislocations (n=6, 1.6%). Involvement was at one level in 290 patients (77.9%), two levels in 61 patients (16.4%), three levels in 15 patients (4.0%), and four levels in six patients (1.6%). The most common localization was the thoracolumbar spine (transition zone) with 275 fractures (57.2%). The causes of fractures were fall from height in 211 patients (56.7%), traffic accidents in 145 patients (39.0%), and direct trauma in 16 patients (4.3%). Associated fractures were detected in 110 patients (29.6%), the most common being calcaneus fractures in 35 patients (9.4%). Apart from orthopedic problems, 38 patients (10.2%) had other organ injuries and/or head trauma. Treatment was conservative in 302 patients (81.2%) and surgical in 70 patients (18.8%). Conclusion: Every patient presenting after a high-energy trauma should be regarded as having a vertebra fracture until proven otherwise. When a vertebra fracture is detected, investigation should be extended for involvement at other levels and associated injuries.

Keywords:

Spinal Fractures, Thoracic Vertebrae, Lumbar Vertebrae, Wounds and Injuries,

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