Study On Correlation Between Thoracolumbar Fractures And Renal Injury And Clinical Significance Of Early Occult Blood Test

ObjectiveThoracolumbar fracture may be associated with pleural and abdominal organ injury. Patients of thoracolumbar fractures combined with renal injury are commonly seen in clinical treatment. Diagnosing comprehensively and timely, reducing missed diagnosis and misdiagnosis, are several basic requirements to improve the medical quality and protect the safety of patients. For lower back injury, many physicians often merely consider the possibility of thoracolumbar fractures and ignore the consideration of renal injury in outpatient and emergency works and it is more likely takeplace especially in case of patients without gross hematuria obviously. Missed or delayed diagnosis may not only affect the prognosis of renal injury, but also make "attack for twice" caused by improper treatment for kidney thereby. So it has important clinical significance to explore the possibility of thoracolumbar fractures combined with renal injury. It is proved that detection of urine occult combined with dry chemical method is a simple, rapid approach for early detecting urinary injury. Moverover, it can further raise the accuracy of hematuria test combined with urinary sediment microscopy. Detecting the possibility of renal injury earlier by urine occult, further defining the degree and position of renal injury combined with relevant imaging examination, rendering for selecting reasonable choice of treatments.MethodsDuring the period of January 2013 to December 2014, outpatients with thoracolumbar-surrounding injury were given with imaging examination and early urine analysis in emergency department of liaocheng people’s hospital. The positive cases of urine cccult were further combined with microscopic examination of urine sediment. Patients with thoracolumbar fractures need to be excluded by the possibility of old fracture, as well as the possibility of pathological fracture owing to several factors such as tumor and bone disease, et al. The positive cases of urine occult need to be ruled out by the possibility of urinary system bleeding outside kidney, or affected by urinary infection, obstruction, occupying, drug, menstruation and other factors. Analysis the causes of injury and the results of urine occult of valid cases, all of the positive cases of urine occult were evaluated by AIS-ISS (2005). Design forms and analysis the relationship between the positive rate of urine occult with the causes、fracture distribution and the severity of injury.ResultsA total of 274 valid cases were collected,95 cases merger with hematuria, of which 32 cases with gross hematuria, and the positive rate of hematuria were 34.7% overall. According to the AAST classification, there were 88 cases of renal injury with Ⅰ～Ⅳ grade,7 cases with V grade, and 13 cases were underwent operation.① Causes of injury:there are 179 cases of traffic injuries, combined with 44 cases of hematuria, the positive rate was 24.6%; 53 cases of blunt force trauma, combined with 34 cases of positive urine occult, the positive rate was 64.2%; and 42 cases of falling injuries, combined with 17 cases of hematuria, the positive rate was 40.5%. The rate of traffic injury is significantly higher than other causes of thoracolumbar fractures. Thoracolumbar fractures caused by blunt force injuries have higher rate of combining hematuria than any other injuries, after statistical analysis, the difference was statistically significant (P<0.05).② Distribution of the fracture:There are 187 cases involving the thoracolumbar segment (T11～L2) fractures, accounting for 68.2% of the new thoracolumbar fractures, and 57 cases combined with hematuria, the positive rate was 30.7%. In addition,98 cases were non- thoracolumbar segment fractures, and 41 cases combined with hematuria, the positive rate was 41.8%. After statistical analysis, the difference was statistically significant (P<0.05).③ Extent of body damage:There were 58 cases with ISS<16 points among 95 cases of hematuria, accounting for 61.1%; and 37 cases with ISS>16 points, accounting for 38.9%.Conclusion① The possibility of thoracolumbar fractures associated with renal injuries may exist, thoracolumbar fractures caused by blunt force injuries have higher risk of combing with renal injury than other injuries.② The thoracolumbar segment (T11-L2) spine is a high incidence zone of thoracolumbar fractures, but the rate of thoracolumbar segment fractures combined with renal injuries is lower than the non-thoracolumbar segment fractures.③ Looking from the extent of body damage, Patients of thoracolumbar fractures combined with positive urine occult most belong to minor injuries (ISS<16), hematuria most belong to microscopic hematuria.④ Examination of urine occult is a simple and reliable method for early detection of renal injury, and it might be the preferred method of renal injury screening.