33 / 2017-07-04 22:49:54

Traumatic diaphragmatic hernia associated with the spine fracture: a retrospective observational study of 18 patients

diaphragmatic hernia,the spine fracture,hernia contents,missed diagnosis,injury mechnism

Background: Traumatic diaphragmatic hernia (TDH) was generally considered to be a marker of severe trauma. Traumatic diaphragmatic hernia associated with the spine fracture was few reported. The thoroughly understanding the particular injury would be benefit for diagnosis and treatment early avoiding delayed or missed diagnosis. Purpose: To explore the potential clinical characteristics and mechanism of TDH combined with the spine fracture.Study design: The retrospective observational study of clinical cases. Patient sample: The clinical datas of 18 patients diagnosed as the spine fracture combined with the diaphragmatic hernia were analyzed from our hospitals between July 1887 and September 2012. All cases of penetrating injury of the diaphragm were excluded.Outcome measures: The primary outcome measure was the comparison of the rate of for different types of injury, different organ injury, diagnosis time, the side of diaphragmatic injury, hernia contents, the segment of spine fracture or sex. Secondary outcomes were the diaphragmatic and spinal cord impairment Scale with using AAST and ASIA. Methods: Eighteen TDH patients, were included in this retrospective in our centre between July 1887 and September 2012. All cases of penetrating injury of the diaphragm were excluded. The etiological factors, injury mechnism, diagnosis, and other factors were analyzed and discussed. The study was approved by the Shanxi Medical Association Medical Ethics Committee. No commercial or other source of funding was received. Results: The mean age was 34.7 years with a female to male ratio of 1/17. TDH was right-sided in 5.6% (n = 1) and left-sided in 94.4% (n = 17). The cause of the diaphragmatic rupture was crush injury 15 (83.3%), and free fall trauma in 3 (16.7%). Only five patients (27.8%) had late diagnosis. Associated injuries were seen in 88.9% (n = 16) of the patients. Morbidity and mortality were encountered in 72.2% (n = 13) and 5.6% (n = 1) patients, respectively. Conclusions: Although the spine fracture accompanied with traumatic diaphragmatic hernia is very rare, diaphragmatic henia must be suspected in any patient with spinal fracture, especially for thoracolumbar fracture. Early diagnosis of TDH is sometimes difficult and depends on a high index of suspicion. The diaphragmatic hernia was easily missed for months to years after the injury. Most diaphragmatic ruptures occur in the left posterolateral aspect of the diaphragm. The spinal fractures should be treated concurrently with diaphragmatic hernia.