Rolul intervenţiilor chirurgicale de decompresie şi stabilizare în tratamentul consecinţelor traumatismelor vertebrale grave

Abstract

Sunt prezentate rezultatele tratamentului chirurgical la 88 de pacienţi cu traumatism vertebro-medular în diferite perioade ale maladiei traumatice. Laminectomie şi hemilaminectomie decompresivă s-a efectuat la 16 pacienţi(18,2%), rahisinteză dorsală cu plăci xHииOT s-a efectuat la 20(22,7%) de pacienţi şi rahisinteză dorsală cu sistem CD modificat de autor s-a efectuat la 52 de pacienţi(59,1%). Stabilizarea segmentelor vertebrale afectate cu implante metalice de stabilizare dorsală au permis activizarea precoce a pacienţilor fără aplicarea imobilizării externe gipsate. Sistemele de stabilizare segmentară vertebrală au permis restabilirea precoce a funcţiei de suport a coloanei vertebrale cu scop de activizare precoce şi verticalizare a bolnavilor în perioada postoperatorie.

Spinal and medullar lesion, despite preventive measures and their high incidence, still have a leading position among the severe disability conditions and rank the third on the scale of traumatic diseases being left behind only by the cylindrical and craniocerebral traumas. The contemporary approach of treatment for spinal and medullar traumatic disease (SMTD)includes a programme of surgical and orthopaedic treatment and rehabilitation, all these aimed at excluding the causes of neurological disturbances and restoring hemo-and liquor circulations, as well as the stimulation of compensatory mechanisms. We examined and treated 88 patients: 32 women, 56 men, aged 11-65 with SMTD at different periods (24hrs to 3, 5 years) of spine trauma. The patients we subjected to different surgical procedures: - posterior stabilization wirh Cotrel-Dubousset Instrumentation (CDI) and posterior spondylodesis – 52(59,1%) patients - spine decompression (laminectomy) and posterior stabilization with xHииOT plate – 20(22,7%) patients - spinal canal reconstruction through posterior and posterior-lateral approach 16(18,2%) patients. In the postoperative period all patients have been administered medication aiming at restoration and improvement of body function: pain and inflammation therapy, regulation of muscle tone. Rehabilitation plan was individual and included physical activity, psychotherapy, exercise therapy, electrotherapy, ultrasound, limb massage have been introduced 3-4 days after surgery and recommended to recur in 2-3 months. The positive outcome results in both complicated and non-complicated SMTD have always depended upon the timely surgical treatment and rehabilitation. Surgical treatment in combination with the adequate rehabilitation regimen allows achieving good physical professional and psychosocial results.