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Polytrauma

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Chirurgie der verletzten Wirbelsäule

Zusammenfassung

Wirbelsäulenverletzungen sind häufig mit schweren Begleitverletzungen kombiniert und damit potenziell lebensbedrohlich. Sie werden im Rahmen des modernen Schockraum-Managements mit Ganzkörper-CT heute bei mehr als 40% der Patienten gefunden. Hoch instabile Verletzungen müssen zur Sicherstellung einer Intensivtherapie stabilisiert werden und bilden hinsichtlich zeitlicher Planung und Verfahrenswahl eine Herausforderung.

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Literatur

  • Anderson LD, D’ Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974; 56A: 1663-1674

    Google Scholar 

  • Anderson PA, Montesano PX Morphology and treatment of occipital condyle fractures. Spine 1988; 13: 731-736

    Article  PubMed  CAS  Google Scholar 

  • Berne JD, Velmahos GC, El-Tawil Q, et al. Value of complete cervical helical computed tomographic scanning in identifying cervical spine injury in the unevaluable blunt trauma patient with multiple injuries: a prospective study. J Trauma 1999; 47: 896-902

    Article  PubMed  CAS  Google Scholar 

  • Beaunoyer M, St-Vil D, Lallier M, Blanchard H. Abdominal injuries associated with thoraco-lumbar fractures after motor vehicle collision. J Pediatr Surg 2001; 36: 760-762

    Article  PubMed  CAS  Google Scholar 

  • Blauth M, Knop C, Bastian L, Krettek C. Lange U Komplexe Verletzungen der Wirbelsäule. Orthopäde 1998; 27:17-31

    PubMed  CAS  Google Scholar 

  • Boerger TO, Limb D, Dickson RA. Does »canal clearance« affect neurological outcome after thoracolumbar burst fractures? J Bone Joint Surg Br 2000;82: 629-635

    Article  PubMed  CAS  Google Scholar 

  • Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev 2002; CD001046

    Google Scholar 

  • Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322: 1405-1411

    CAS  Google Scholar 

  • Bracken MB, Shepard MJ, Holford TR, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. JAMA 1997; 277: 1597-1604

    Article  PubMed  CAS  Google Scholar 

  • British Trauma Society 2002. Guidelines for initial management and assessement of spinal injury. Injury Int J Care Injured 2003; 34: 405-425

    Google Scholar 

  • Brodke DS, Anderson PA, Newell DW, Grady MS, Chapman JR. Comparison of anterior and posterior approaches in cervical spinal cord injuries. J Spinal Disord Tech 2003; 16: 229-235

    Article  PubMed  Google Scholar 

  • Bühren V. Frakturen und Instabilitäten der Halswirbelsäule. Unfallchirurg 2002; 73: 1049-1066

    Google Scholar 

  • Bühren V. Verletzungen der Brust- und Lendenwirbelsäule. Unfallchirurg 2003; 106:55-69

    Article  PubMed  Google Scholar 

  • Bühren V. Minimalinvasive Techniken in der Wirbelsäulenchirurgie. Trauma und Berufskrankheit 2004; 6(4): 464-467

    Article  Google Scholar 

  • Bühren V., Potulski M., Jaksche H. Chirurgische Versorgung bei Tetraplegie. Unfallchirurg 1999; 102: 2-12

    Article  PubMed  Google Scholar 

  • Chipman JG, Deuser WE, Beilman GJ. Early surgery for thoracolumbar spine injuries decreases complications. J Trauma 2004; 56: 52-57

    Article  PubMed  Google Scholar 

  • Coleman WP, Benzel D, Cahill DW, et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13: 185-199

    Article  PubMed  CAS  Google Scholar 

  • CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10.008 adults with clinically significant head injury (MRC CRASH trial): randomised placebocontrolled trial. Lancet 2004; 364: 1321-1328

    Article  Google Scholar 

  • Crim JR, More K, Brodke D. Clearance of the cervical spine in multitrauma patients: the role of advanced imaging. Semin Ultrasound CT MR 2001;22: 283-305

    Article  PubMed  CAS  Google Scholar 

  • Croce MA, Bee TK, Pritchard E, Miller PR, Fabian TC. Does optimal timing for spine fracture fixation exist? Ann Surg 2001; 233: 851-858

    Article  PubMed  CAS  Google Scholar 

  • Daentzer D, Böker DK. Operative Stabilisierung traumatischer Instabilitäten der unteren Halswirbelsäule. Erfahrungen mit einem nicht winkelstabilen ventralen Platten-Schrauben-System bei 95 Patienten. Unfallchirurg 2004; 107: 175-180

    Article  PubMed  CAS  Google Scholar 

  • Dai LY, Yao WF, Cui YM, Zhou Q. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment – a review of 147 cases. J Trauma 2004; 56: 348-355

    Article  PubMed  Google Scholar 

  • Dalvie SS, Burwell M, Noordeen MH. Haemothorax and thoracic spinal fracture. A case for early stabilization. Injury 2000; 31: 269-270

    Article  PubMed  CAS  Google Scholar 

  • Delamarter RB, Sherman JE, Carr JB. Volvo award in experimental studies. Cauda equina syndrome: neurologic recovery following immediate, early, or late decompression. Spine 1991; 16: 1022-1029

    Article  PubMed  CAS  Google Scholar 

  • Dolan EJ, Tator CH, Endrenyi L. The value of decompression for acute experimental spinal cord compression injury. J Neurosurg 1980; 53: 749-755

    Article  PubMed  CAS  Google Scholar 

  • Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA. Fractures of the ring of the axis: A classification based on the axis of 131 cases. J Bone Joint Surg Br 1981; 63B: 319-327

    Google Scholar 

  • Fehlings MG, Sekhon LH, Tator C. The role and timing of decompression in acute spinal cord injury: what do we know? What should we do? Spine 2001; 26: 101-110

    Article  Google Scholar 

  • Fehlings MG, Tator CH. An evidence-based review of decompressive surgery in acute spinal cord injury: rationale, indications and timing based on experimental and clinical studies. J Neurosurg Spine 1999; 91: 1-11

    Article  CAS  Google Scholar 

  • Galandiuk S, Raque G, Appel S, Polk HC, Jr. The two-edged sword of largedose steroids for spinal cord trauma. Ann Surg 1993; 218: 419-427

    Article  PubMed  CAS  Google Scholar 

  • Gerndt SJ, Rodriguez JL, Pawlik JW, Taheri PA, Wahl WL, Micheals AJ, Papadopoulos SM. Consequences of high-dose steroid therapy for acute spinal cord injury. J Trauma 1997; 42: 279-284

    Article  PubMed  CAS  Google Scholar 

  • Glaesener JJ, Hasse W, Exner G, Mikschas V. Thorakopulmonale Komplikationen bei frischen Frakturen der Brustwirbelsäule mit neurologischem Schaden. Unfallchirurgie 1992; 18: 274-279

    Article  PubMed  CAS  Google Scholar 

  • Gonzalez RP, Fried PO, Bukhalo M, Holevar MR, Falimirski ME. Role of clinical examination in screening for blunt surgical spine injury. J Am Coll Surg 1999; 189: 152-157

    Article  PubMed  CAS  Google Scholar 

  • Griffen MM, Frykberg ER, Kerwin AJ, et al. Radiographic clearance of blunt cervical spine injury: Plain radiograph or computed tomography scan? J Trauma 2003; 55: 222-227

    Article  PubMed  Google Scholar 

  • Harris MB, Kronlage SC, Carboni PA, et al. Evaluation of the cervical spine in the polytrauma patient. Spine 2000; 25: 2884-2891

    Article  PubMed  CAS  Google Scholar 

  • Hasse W, Weidtmann A, Voeltz P. Laktatazidose: ein Komplikation beim querschnittgelähmten Polytrauma. Unfallchirurg 2000; 103: 495-498

    Article  PubMed  CAS  Google Scholar 

  • Hauser CJ, Visvikis G, Hinrichs C, et al. Prospective validation of computed tomographic screenig of the thoracolumbar spine in trauma. J Trauma 2003; 55: 228-235

    Article  PubMed  Google Scholar 

  • Hebert JS, Burnham RS. The effect of polytrauma in persons with traumatic spine injury. A prospective database of spine fractures. Spine 2000; 25: 55-60

    Article  PubMed  CAS  Google Scholar 

  • Holmes JF, Panacek EA, Miller PQ, Lapidis AD, Mower WR. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. Emerg Med 2003; 24: 1--7

    Article  Google Scholar 

  • Hsu JM, Joseph T, Ellis AM. Thoracolumbar fracture in blunt trauma patients: Guidelines for diagnosis and imaging. Injury Int J Care injured 2003; 34:426-433

    Google Scholar 

  • Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg Spine 2000; 93: 1-7

    Article  CAS  Google Scholar 

  • Johnson KD, Cadambi A, Seibert BG. Incidence of adult respiratory distress syndrome in patients with multiple musculosceletal injuries: effect of early operative stabilization of fractures. J Trauma 1985; 25: 375-384

    Article  PubMed  CAS  Google Scholar 

  • Josten C, Katscher S. Radiologische Diagnostik bei Wirbelsäulenverletzungen. Akt Traumatol 2003; 33: 157-164

    Article  Google Scholar 

  • Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Murphy T, Tepas JJ. The effect of early spine fixation on non-neurologic outcome. J Trauma 2005; 58: 15-21

    Article  PubMed  Google Scholar 

  • Knop C, Blauth M, Bühren V, et al. Operative Behandlung von Verletzungen des thorakolumbalen übergangs – Teil 3: Nachuntersuchung. Ergebnisse einer prospektiven multizentrischen Studie der Arbeitsgemeinschaft »Wirbelsäule« der Deutschen Gesellschaft für Unfallchirurgie. Unfallchirurg 2001; 104: 583-600.

    Article  PubMed  CAS  Google Scholar 

  • Kohler A, Friedl HP, Kach K, Stocker R, Trentz O. Versorgungskonzept beim Polytraumatisierten mit Halswirbelsäulenverletzung. Helv Chir Acta 1994; 60: 547-550

    PubMed  CAS  Google Scholar 

  • Koivikko MP, Myllynen P, Karjalainen M, Vornanen M, Santavirta S. Conservative and operative treatment in cervical burst fractures. Arch Orthop Trauma Surg 2000; 120: 448-451

    Article  PubMed  CAS  Google Scholar 

  • Kossmann T, Trease L, Freedman I, Malham G. Damage control surgery for spine trauma. Injury 2004; 35: 661-670

    Article  PubMed  Google Scholar 

  • La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F. Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a metaanalytical approach. Spinal Cord 2004; 42: 503-512

    Article  PubMed  Google Scholar 

  • Limb D, Shaw DL, Dickson RA. Neurological injury in thoracolumbar burst fractures. J Bone Joint Surg Br 1995; 77: 774-777

    PubMed  CAS  Google Scholar 

  • Link TM, Schuierer G, Hufendiek A, Peters PE. HWS-Frakturen. Diagnostik bei polytraumatisierten Patienten. Radiologe 1994; 34: 721-727

    PubMed  CAS  Google Scholar 

  • McLain RF, Benson DR. Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine 1999; 24: 1646-1654

    Article  PubMed  CAS  Google Scholar 

  • Miller CD, Blyth P, Cicil ID. Lumbar transverse process fractures – a sentinel marker of abdominal organ injuries. Injury 2000; 31: 773-776

    Article  PubMed  CAS  Google Scholar 

  • Novelline RA, Rhea JT, Rao PM, Stuk JL. Helical CT in emergency radiology. Radiology 1999; 213: 321-339

    PubMed  CAS  Google Scholar 

  • Otani K, Abe H, Kadoya S, et al. Beneficial effect of methylprednisolone sodium succinate in the treatment of acute spinal cord injury [in Japanese]. Spine and Spinal Cord 1994; 7: 633-647

    Google Scholar 

  • Pape HC, Stalp M, Dahlweid M, Regel G, Tscherne H. Welche primäre Operationsdauer ist hinsichlich eines »Borderline-Zustandes« polytraumatisierter Patienten vertretbar? Unfallchirurg 1999; 102: 861-869

    Article  PubMed  CAS  Google Scholar 

  • Patten RM, Gunberg SR, Brandenburer DK. Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology 2000; 215: 831-834

    PubMed  CAS  Google Scholar 

  • Petitjean ME, Mousselard H, Pointillart V, Lassie P, Senegas J, Dabadie P. Thoracic spinal trauma and associated injuries: should early spinal decompression be considered? J Trauma 1995; 39: 368-372

    Article  PubMed  CAS  Google Scholar 

  • Platz A, Ertel W, Helmy N, Stocker R, Trentz O, Pfammatter T. Erfahrungen mit dem Einsatz eines potentiell temporären Vena Cavafilters beim mehrfachverletzten Patienten. Chirurg 2001; 72: 717-722

    Article  PubMed  CAS  Google Scholar 

  • Pointillart V, Petitjean ME; Wiart L, Vital JM, Lassié P, Thicoipé M, Dabadie P. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord 2000; 38: 71-76

    Article  PubMed  CAS  Google Scholar 

  • Richter-Turtur M. Wirbelsäulenverletzungen bei polytraumatisierten Patienten. Langenbecks Arch Chir Suppl Kongressbd 1992; 109: 311-315

    Google Scholar 

  • Sauerland S, Nagelschmidt M, Mallmann P, Neugebauer EAM. Risks and benefits of preoperative high dose methylprednisolone in surgical patients: a systematic review. Drug Saf 2000; 23: 449-461

    Article  PubMed  CAS  Google Scholar 

  • Schenarts PJ, Diaz J, Kaiser C, Carrillo Y, Eddy V, Morris JA . Prospektive comparison of admission computed tomographic scan and plain films of the upper cervical spine in trauma patients with altered mental status. J Trauma 2001; 51: 663-668

    Article  PubMed  CAS  Google Scholar 

  • Schinkel C, TM Frangen, A Kmetic, H-J Andress, G Muhr, AG Polytrauma der DGU. Wirbelsäulenfrakturen bei Mehrfachverletzten. Eine Analyse des DGU Traumaregisters. Unfallchirurg 2007; 110: 946-952

    Article  PubMed  CAS  Google Scholar 

  • Schlegel J, Bayley J, Yuan H, Fredricksen B. Timing of surgical decompression and fixation of acute spinal fractures. J Orthop Trauma 1996; 10: 323-330

    Article  PubMed  CAS  Google Scholar 

  • Short D. Is the role of steroids in acute spinal cord injury now resolved? Curr Opin Neurol 2001; 14: 759-763

    Article  PubMed  CAS  Google Scholar 

  • Short DJ, El Masry WS, Jones PW. High dose methylprednisolone in the management of acute spinal cord injury – a systematic review from a clinical perspective. Spinal Cord 2000; 38: 273-286

    Article  PubMed  CAS  Google Scholar 

  • Silber JS, Vaccaro AR. Summary statement: the role and timing of decompression in acute spinal cord injury: evidence-based guidelines [comment]. Spine 2001; 26: 110

    Article  Google Scholar 

  • Svennevig JL, Bugge-Asperheim B, Vaage J, Geiran O, Birkeland S. Corticosteroids in the treatment of blunt injury of the chest. Injury 1984; 16: 80-84

    Article  PubMed  CAS  Google Scholar 

  • Van Beek EJ,Been HD, Ponsen K-J, Maas M. Upper thoracic spinal fractures in trauma patients – a diagnostic pitfall. Injury 2000; 31: 219-223

    Article  PubMed  CAS  Google Scholar 

  • Waydhas C, Nast-Kolb D, Kick M, et al. Operationstrauma Wirbelsäule in der Versorgung polytraumatisierter Patienten. Unfallchirurg 1993; 96: 62-5

    PubMed  CAS  Google Scholar 

  • Wessberg P, Wang Y, Irstam L, Nordwall A. The effect of surgery and remodelling on spinal canal measurements after thoracolumbar burst fractures. Eur Spine J 2001; 10: 55-63

    Article  PubMed  CAS  Google Scholar 

  • Woltmann A, Bühren V. Schockraummanagement bei Verletzungen der Wirbelsäule im Rahmen eines Polytraumas. Eine systematische Literaturübersicht. Unfallchirurg 2004; 107: 911-918

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Murnau (BGU), Traumachirurgie, Prof. Küntscher-Str. 8, 82418, Murnau

    Prof. Dr. med. A. Woltmann

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  1. Prof. Dr. med. A. Woltmann
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  1. Murnau, Garmisch-Partenkirchen

    Volker Bühren

  2. Leipzig

    Christoph Josten

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Woltmann, A. (2013). Polytrauma. In: Bühren, V., Josten, C. (eds) Chirurgie der verletzten Wirbelsäule. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-02208-1_25

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  • DOI: https://doi.org/10.1007/978-3-642-02208-1_25

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