颈脊髓损伤早期死亡临床研究

目的分析研究颈脊髓损伤(CSCI)早期死亡情况,探讨颈脊髓损伤早期死亡的主要影响因素及发生机理。方法收集整理2004-02-2012-02入院的131例CSCI患者的临床资料(早期死亡15例),分析CSCI早期死亡者的年龄、性别、受伤原因、脊柱损伤节段、脊髓损伤严重程度、是否手术及气管切开、是否存在低钠血症、是否存在低蛋白血症与CSCI早期死亡的关系,总结CSCI早期死亡的原因。结果 CSCI早期死亡率为8.40%(11/131),多死于呼吸功能衰竭。性别、受伤原因及是否手术统计分析,差异无统计学意义(P>0.05);颈髓不同损伤程度、颈髓不同损伤节段、不同年龄段、气管是否切开、是否存在低钠血症及是否存在低蛋白血症统计分析,差异有统计学意义(P<0.05或P<0.001)。结论呼吸衰竭是CSCI早期死亡的首要原因;颈髓不同损伤程度、颈髓不同损伤节段、不同年龄段、气管是否切开、是否存在低钠血症、是否存在低蛋白血症是CSCI早期死亡的主要影响因素。     

颈脊髓损伤后低钠血症与早期死亡的临床分析

目的 分析研究颈脊髓损伤(CSCI)低钠血症的相关因冈素、发病机制及对早期死亡的影响.方法 收集整理2005～2010年入院的131例CSCI患者的临床资料(早期死亡11例),分析CSCI后低钠血症与CSCI节段、损伤程度的关系及对早期死亡的影响.结果 颈脊髓不同损伤程度、不同损伤节段低钠血症发病率的统计分析,相互之间...     

探讨下颈椎损伤并发脊髓损伤的手术效果及影响因素

目的探讨下颈椎损伤并发脊髓损伤的手术效果及影响因素。方法选取2014-05—2017-05间在茂名市人民医院接受手术治疗的80例下颈椎损伤并发脊髓损伤患者。对手术效果及影响因素进行分析。结果 (1)术后随访1a,恢复55例(68.75%),未恢复25例(31.25%),其间死亡6例(7.50%),并发症发生率为10.0%。末次随访根据ASIA分级:A级恢复4例(12.50%),B级恢复15例(71.43%),C级恢复18例(94.74%),D级恢复8例(100.0%)。(2)单因素分析:受伤至就诊时间、术前伤史、伤后椎管侵占率、伤后8 h内使用激素与患者术后脊髓功能的恢复均有明显相关性(P0.05)。但年龄、性别、手术方式、损伤类型、损伤节段及损伤能量与患者术后脊髓功能的恢复无明显相关性(P0.05)。(3)Logistic多因素回归分析:受伤至就诊时间、术前伤史、伤后椎管侵占率、伤后8 h内使用激素,是影响下颈椎损伤并发脊髓损伤患者预后的主要因素。结论对下颈椎损伤并发脊髓损伤患者早期迅速给予有效救治,可提高手术治疗效果,有利于改善术后脊髓神经功能。     

前后路联合复位固定术治疗严重下颈椎骨折脱位

目的观察颈椎前后路联合手术复位固定治疗严重下颈椎骨折脱位的临床效果。方法2003年4月～2006年8月,采用前后路联合手术复位减压固定治疗严重下颈椎骨折脱位合并不同程度脊髓损伤者7例。男5例,女2例;年龄27～42岁。致伤原因:车祸伤5例,高处坠落伤2例,受伤部位C4、54例,C5、63例。Allen分类:屈曲压缩型度4例,牵张屈曲型度3例。完全性瘫痪1例;不完全性瘫痪6例,其中上肢肌力1～2级3例,3～4级3例。脊髓损伤按Frankel分级:A级1例,B级4例,D级2例。于伤后1～8d手术。前路固定采用Orion带锁钢板(颈椎带锁钢板)7例,后路侧块钢板螺钉固定2例,后路钉棒系统固定5例。结果本组术后伤口均期愈合,获随访4～24个月,平均6个月。X线片检查示损伤节段固定稳定,未见内植物松动、脱落及断裂。植骨于3～4个月内均融合。术后4个月脊髓功能按Frankel分级,术前1例A级,术后无恢复;术前4例B级,术后恢复至C级2例可行走,恢复至B级2例可扶拐行走,2例D级恢复至E级,能正常行走。术后4例行CT及MRI检查,颈椎序列均恢复,椎管矢状径达到正常,脊髓受压解除。结论颈椎前后路联合手术复位固定严重下颈椎骨折脱位可使损伤节段获得早期稳定,方便术后护理和早期功能锻炼,有利于脊髓功能恢复。     

胸椎骨折伴胸骨骨折9例分析

目的对胸椎骨折伴发胸骨骨折进行初步探讨与分析。方法自2001年11月至2006年l0月，共收治胸椎骨折伴胸骨骨折患者9例，全部病例行X线、CT及MRI检查。根据患者年龄、性别、受伤原因、胸骨骨折部位、胸椎损伤节段及类型、脊髓损伤程度及其他合并伤等资料均作为相关信息列入分析。结果损伤原因以交通伤和坠落伤为主，3例为多节段骨折，9例合并多发创伤或多发骨折。脊髓损伤发生率高，损伤程度严重。结论胸椎骨折伴胸骨骨折的临床特点为致伤暴力强大，脊柱骨折、脊髓损伤严重，合并多发伤发生率高。胸骨是胸廓环的重要组成结构，并在维持胸椎的稳定性中发挥着重要的作用。     

颈髓损伤早期死亡影响因素与时间分布

目的探讨颈髓损伤患者的早期死亡率和影响因素，了解颈髓损伤患者早期死亡的时间分布及其影响因素。方法收集整理1991年1月至2005年12月伤后20天内入院的1185例颈髓损伤患者的临床资料，统计早期死亡率，通过logistic回归分析考查年龄、性别、工作性质、受伤原因、颈髓损伤程度、颈髓损伤节段、治疗期间营养状况、手术与否及气管切开等因素对于患者早期死亡率的影响；统计患者早期死亡的时间分布，通过Cox多元逐步回归分析考查影响颈髓损伤患者早期死亡时间分布的因素。结果106例患者发生早期死亡，死亡率为8．95％；男92例，女14例。年龄、颈髓损伤程度、颈髓损伤平面、手术与否、气管切开等因素与早期死亡率明确相关。64例患者在伤后10天内死亡，85例患者在伤后半个月内死亡，颈髓损伤节段对患者早期死亡时间分布有明确影响。结论高龄、颈髓完全性损伤、颈髓高位损伤是颈髓损伤患者早期死亡的危险因素；积极的手术治疗有助于降低颈髓损伤患者的早期死亡率；不适当、不必要的气管切开将增加颈髓损伤患者早期死亡的危险性。伤后3-6天是颈髓损伤患者早期死亡的高峰期，80％早期死亡的患者死于伤后15天内；颈髓损伤节段越高，患者早期死亡的时间越早。     

过伸性颈椎脊髓损伤的影像学特征与临床意义

[目的]探讨过伸性颈椎脊髓伤影像学特点,为临床治疗方法选择提供依据。[方法]对本组78例因不同原因造成的颈椎过伸性损伤的影像学表现,包括X线片、CT、MRI不同的影像特征进行回顾性分析。椎前阴影增宽57例（73.1%）,其中36例损伤节段前间隙增宽或伴颈椎前缘撕脱骨折,局限性增宽占17.5%,弥漫性占82.5%退变性和发育性椎管狭窄63例。CT平扫显示椎体前后缘明显退变骨赘形成37例,椎间盘变性突出21例。MRI的特征性表现为椎间盘和前纵韧带损伤61例（78.2%）。椎体前血肿及水肿57例,64例表现脊髓不同程度受压或损伤。根据影像学变化,提出影像学诊断根据。[结果]过伸性颈椎脊髓损伤影像有明显特征性变化,包括骨和前纵韧带、椎间盘及相应节段的脊髓存在特征性变化;脊髓损伤与影像学表现有明显相关性,临床上可能表现典型急性脊髓中央综合征,但多数表现不同程度神经功能障碍。[结论]影像学变化特征结合临床表现特点,为过伸性颈脊髓损伤诊断及其早期治疗方法选择提供影像学依据。     

颈椎前纵韧带损伤的诊断与治疗

目的 探讨颈椎前纵韧带损伤的诊断与治疗.方法 2001年3月至2003年7月经影像学证实为前纵韧带损伤的患者46例.患者均在伤后3 h～3 d内摄颈椎正、侧位X线片并行MRI检查.颈椎椎前阴影增宽35例,椎体不稳征象14例.颈椎MRI T<,1>加权像表现为前纵韧带呈灰色或灰白色信号,部分可见连续性中断、增厚;T<,2>加权像表现为椎体前缘增厚的片状纵行不均匀高信号,边界不清晰,部分可见高信号掀起、连续性中断.19例合并脊髓损伤的患者行早期手术治疗.27例单纯颈部疼痛患者中,早期前路手术治疗6例,颈围石膏固定5例,颈托固定16例. 结果 45例患者获6～41个月(平均16.7个月)随访.5例脊髓完全性损伤患者术后有2例转为不完全性损伤,14例脊髓不完全损伤患者术后有10例获得不同程度的好转.21例单纯颈部疼痛患者中,早期手术的6例无神经症状患者随访时未发生颈椎后凸畸形及颈部慢性疼痛症状;21例早期保守治疗的患者中,7例伤后4～6周因存在颈椎不稳征象而行颈椎前路手术,2例伤后2～3年因损伤节段椎间盘退变突出压迫脊髓而行前路减压植骨内固定术,3例有慢性颈部疼痛不适,余8例患者无特殊不适主诉,另1例失访.结论 MRI检查是诊断颈椎前纵韧带损伤最有价值的方法.合并脊髓受压征象或椎间严重不稳的颈椎前纵韧带损伤,可早期行减压融合术;不伴脊髓损伤的颈椎前纵韧带合并椎间盘损伤,可考虑早期行前路椎间盘切除融合术.     

非手术治疗无骨折脱位型颈脊髓损伤预后的多因素分析

目的 :探讨影响非手术治疗无骨折脱位型颈脊髓损伤预后的因素。方法 :回顾性分析2009年1月至2012年12月接受非手术治疗的122例无骨折脱位型颈脊髓损伤患者的临床资料,其中男84例,女38例;平均年龄(52.37±13.27)岁(18~83岁)。选择年龄、性别、受伤原因、受伤至治疗时间、脊髓损伤ASIA分级、MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、椎间盘突出节段、椎间盘韧带复合体损伤、大剂量甲基强的松龙冲击治疗12个可能对非手术治疗预后产生影响的因素,应用单因素和多因素Logistic回归分析,研究其对预后的影响。结果:单因素分析显示MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、椎间盘突出节段及脊髓损伤ASIA分级均对预后有显著影响(P均0.05)。进一步行多因素分析,按照其作用强度,影响预后的主要因素依次为:MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、脊髓损伤ASIA分级(P均0.05)。结论 :影响非手术治疗无骨折脱位型颈脊髓损伤预后的主要因素是MRI脊髓损伤类型及范围,同时与有效椎管率、椎间盘突出程度及脊髓损伤ASIA分级相关。对于选择非手术治疗需谨慎,仅适用MRI检查提示脊髓信号无改变或水肿程度轻且范围局限者,其余则建议积极手术治疗。     

早期手术治疗急性颈脊髓损伤

目的 探讨早期手术治疗急性严重颈脊髓损伤的临床效果。方法 自1999～2002年对24例急性颈脊髓损伤的患者进行早期手术治疗，受伤到手术的平均时间为67h，手术方式包括颈椎前路手术、后路手术及前后路联合手术，对损伤的颈椎节段实施复位、减压、固定和融合。结果 22例获得12．38个月(平均18个月)的随访，除11例全瘫者中的2例无恢复外，其他病例均有不同程度的恢复，ASIA分级平均提高1．8个等级，无并发症发生。结论 对急性严重颈脊髓损伤，早期实施手术治疗可取得满意的治疗效果。     

Persistent hypoalbuminemia is a predictor of outcome in cervical spinal cord injury

Background contextHypoalbuminemia is associated with increased morbidity and mortality in various clinical settings and several major diseases. Albumin has multiple physiologic properties that could be beneficial in central nervous system injury.PurposeWe sought to determine if albumin is associated with patient outcome after cervical spinal cord injury by conducting a retrospective analysis.Study design/settingA retrospective study of cervical spinal cord injury (CSCI) patients was conducted to investigate if serum albumin levels and other characteristics influence outcome (mechanical ventilation and death).Patient sampleA total of 178 consecutive patients were included in the present study.Outcome measuresDemographic data were recorded, including age, gender, smoking history, time from injury to admission, severity of neurologic injury, neurologic level of lesion, mechanism of neurologic injury, Glasgow Coma Score, vitals in the Orthopedic Department, the occurrence of early surgical intervention (48 hours after injury), and daily serum albumin levels.MethodsNo funds were received in support of this work. No specific conflicts of interest were involved in this article. Serum albumin levels and other characteristics known to influence outcome were included in univariate statistical analyses and the multiple logistic regression model to analyze the relationship with mechanical ventilation and death after cervical injury.ResultsApproximately 41.0% (73/178) of patients had complete spinal cord injury (ASIA A), 36.5% (65/178) of patients required mechanical ventilation, and 8.4% (15/178) of patients died within the first month after injury. Albumin remained lower than 30 g/L for a period of time (≥5 days) in patients with an unfavorable outcome (patients requiring mechanical ventilation or who had died). Multiple logistic regression analysis identified age (>50 years), persistent hypoalbuminemia (<30 g/L and ≥5 days), C5 and above neurologic injury, and ASIA A as predictors for mechanical ventilation. In addition, persistent hypoalbuminemia, ASIA A, and C4 and above neurologic injury were significantly associated with death.ConclusionSimilar to the ASIA scale and neurologic level, persistent hypoalbuminemia seems to be an independent predictor of outcome in patients with CSCI. Thus, a randomized trial assessing albumin in the treatment of cervical spinal cord injury is warranted.     

骨盆骨折伴颈脊髓损伤的临床分析

目的 探讨伴有颈脊髓损伤的骨盆骨折的临床特征。方法 总结和分析187例骨盆骨折患者中伴有颈脊髓损伤的48例骨盆骨折的临床特征。结果 按照损伤机制分型，以前后挤压型骨盆骨折中伴休克和颈髓损伤最多；颈髓损伤平面上移和程度加重以伴有休克者最明显；低钠血症是此类损伤早期常见的并发症。结论 重视此类损伤的病史特点。详细的颈部检查，了解其损伤的机制分型，严格控制液体入量，尽早应用抗再灌注损伤的药物，严密监测低钠血症的相关数据，则有助于此类损伤的早期救治。     

Delayed apnea in patients with mid- to lower cervical spinal cord injury

STUDY DESIGN: A retrospective study of 36 patients with mid- to lower cervical spinal cord injury (CSCI) divided into two groups based on whether delayed apnea developed. OBJECTIVES: To determine nonpulmonary risk factors associated with the development of delayed apnea in mid- to lower cervical spinal cord injury. SUMMARY OF BACKGROUND DATA: Patients with mid- to lower cervical spinal cord injury are generally at lower risk of developing respiratory failure than those with high cervical spinal cord injury. Respiratory failure manifesting as sudden apnea may occur days or even weeks after injury without any pulmonary complications in such patients. METHODS: An index group of eight patients with complete mid- to lower cervical spinal cord injury in whom delayed catastrophic apnea occurred were reviewed. Another group of 28 patients with cervical spinal cord injury of identical magnitude and presentation but without respiratory failure served as the control group. Six parameters presumed to be related to the delayed apnea were analyzed. RESULTS: The extent of cord lesions was significantly different, being diffuse in most of the index patients, but focal in the majority of the control patients (P<0.001). Involvement of the C4 segment of cord appeared to be more frequent in the index group; however, the difference was not statistically significant (P = 0.091). The incidence of transient bradycardia (P<0.01) and dyspnea (P<0.001) in the index group was significantly higher than in the control group. Paralytic ileus was a much rarer event and found to be unrelated to the occurrence of apnea. In five of the eight index patients, the apnea occurred during sleep. Six of the eight index patients died of it. CONCLUSIONS: Delayed but devastating apnea may develop in patients with mid- to lower cervical cervical spinal cord injury, even when they are clinically stable and free from any pulmonary complications. The presence of diffuse, extensive cord lesions, respiratory distress, or bradycardia with or without associated hypotension, however transient and self-limited, should be regarded as warning signs. Sleep was found to be a risky period of time.     

不同程度颈脊髓损伤后低钠血症的临床分析

 目的回顾性总结急性颈脊髓损伤后低钠血症的发生特点,并分析其可能的发生原因,以及脊髓损伤严重程度、性别、年龄等因素对血钠变化的影响。方法研究对象为2005年6月至2011年3月急诊收治的一组颈椎外伤患者,排除合并颅脑外伤及慢性疾病的患者,入选病例分为完全性脊髓损伤组、不完全性脊髓损伤组及无神经功能障碍组,回顾性分析各组病例的血钠变化情况。结果入选病例共102例,男83例,女19例;年龄17~68岁,平均45.6岁。完全性脊髓损伤组23例,不完全性脊髓损伤组60例,无神经功能障碍组19例。共发生低钠血症共39例,完全性脊髓损伤组15例(65%),不完全性脊髓损伤组23例(38%),无神经功能障碍组1例(5%)。低钠血症发生率在三组间两两比较,差异有统计学意义,完全性脊髓损伤组低钠血症的发生率明显高于不完全性脊髓损伤组和无神经功能障碍组。Logistic逐步回归分析结果显示低钠血症与患者脊髓损伤程度有明确相关关系,而与患者的年龄、性别、脊髓损伤节段无相关关系。结论急性颈脊髓损伤后具有较高的低钠血症发生率,虽然影响钠盐平衡的因素及相互作用非常复杂,但颈脊髓损伤致自主神经功能障碍、神经内分泌功能异常以及血液动力学改变可能是导致颈脊髓损伤后电解质系统异常的重要原因。     

急性颈髓损伤后应激性溃疡的临床特点及治疗

目的 :总结急性颈髓损伤后应激性溃疡的临床特点及治疗体会。方法 :将 2 89例急性颈髓损伤患者按是否并发应激性溃疡 ,分为发病组和未发病组 ,并对两组的临床资料进行比较 ,其中包括 :性别、年龄、损伤平面、损伤程度、合并伤、并发症及早期应用激素。同时回顾性分析应激性溃疡的治疗方法。结果 :在年龄≥ 5 5岁、损伤平面在C4以上、完全性脊髓损伤、合并其它脏器损伤、并发肺内感染及早期应用大剂量甲基强的松龙方面 ,发病组与未发病组之间的差异具有显著性意义。经综合治疗 2 4h内出血停止 8例 ,2 4～ 48h出血停止 6例 ,48～ 72h出血停止 1例 ,1例因并发多脏器功能衰竭而死亡。结论 :急性颈髓损伤后应激性溃疡的发生与年龄、颈髓损伤的平面、损伤程度、合并伤、并发肺内感染及脊髓损伤后早期用药有关。诊断后应采取综合治疗     

Intubation after cervical spinal cord injury: to be done selectively or routinely?

Patients with cervical spinal cord injuries (CSCIs) often develop acute respiratory failure and require intubation. It is unknown if intubation should be offered preemptively in all CSCI patients or selectively based on signs of acute respiratory failure. The purpose of this study was to evaluate the role of routine early intubation in CSCI patients. The medical records of 68 patients with CSCI were reviewed. Univariate and multivariate analyses were used to identify independent risk factors for the need of intubation. Statistical significance was considered at P < 0.05. Fifty patients (74%) required intubation and 27 (40%) developed pneumonia. Of patients with CSCI above C5, 87.5 per cent required intubation compared with 61 per cent of patients with CSCI at C5-C8 (P = 0.026). Similarly, of patients with complete quadriplegia, 90 per cent required intubation compared to 48.5 per cent of patients with incomplete quadriplegia or paraplegia (P < 0.001). Of 31 patients not presenting with overt signs of acute respiratory failure on admission, 13 (42%) decompensated later and were eventually intubated up to 53 hours after admission. Six of these 13 patients had emergent intubation due to acute desaturation and developed pulmonary complications associated with emergent intubation. There were 3 independent risk factors for the need of intubation: Injury Severity Score > 16, CSCI higher than C5, and complete quadriplegia. The combination of the 2 latter risk factors resulted in intubation in 21 of 22 patients (95%). The majority of patients with CSCI require intubation. In patients with CSCI above C5 and complete quadriplegia, intubation should be offered routinely and early because delays may cause preventable morbidity.     

颈椎脊髓损伤的治疗现状和进展

颈脊髓损伤多源于交通伤、坠落伤、运动伤或暴力，患者多为青壮年，损伤后可出现截瘫、呼吸障碍甚至死亡。除损伤引起的颈椎管连续性破坏，骨折或脱位压边颈脊髓，后期的继发性损伤也是造成脊髓功能障碍的主要原因、近年来，我国对颈脊髓损伤的治疗取得了很大进步，包括现场急救水平的提高、外科干预和内固定技术的改进、保护神经细胞和促神经生长药物的临床应用、减少继发性损伤、理想的康复等措施，使对颈脊髓损伤患者的救治获得了满意的结果。文章评述了颈脊髓损伤的治疗现状及未来研究的设想。     

老年颈椎间盘损伤相关的脊髓损伤

目的探讨老年颈椎间盘损伤相关脊髓损伤的临床特点、治疗选择和预后。方法回顾1997年1月~2004年1月间收治的60岁以上有完整随访的82例患者资料,对其临床特点、治疗选择和预后进行分析。结果老年颈椎间盘损伤相关的脊髓损伤伤后JOA评分较低,多合并颈椎不稳,并发症多。MRI图像上72%患者脊髓信号改变为2~4个节段,脊髓信号改变平面多于椎间盘损伤平面,且脊髓信号改变的平面高于椎间盘损伤的平面,非手术治疗3个月与手术治疗术后3个月的JOA改善率卡方检验P<0.05,有显著性差异,根据患者伤后至手术时间隔的不同分组计算术后JOA改善率并行卡方检验显示,伤后24h内手术效果最好,与其余各组比较P<0.01,24h~2周组与2~12周组术后JOA改善率P>0.05,12周以后组与其他各组比较术后JOA改善率P<0.01。结论老年颈椎间盘损伤相关的脊髓损伤症状较重,脊髓损伤平面高于椎间盘损伤的平面,易并发呼吸衰竭。手术治疗效果相对较好,且手术治疗时间越早术后JOA改善率越高。     

Extensive spinal cord infarction after posterior fossa surgery in the sitting position: case report

OBJECTIVE AND IMPORTANCE: Spinal cord injury is a rare complication of neurosurgery performed with the patient in the sitting position. Previous reports showed that the level of injury is usually located at or near the C5 segmental spinal level, and the term midcervical quadriplegia has been proposed. Extensive spinal cord and lower brainstem infarction also can occur after posterior fossa surgery performed with the patient in the sitting position. CLINICAL PRESENTATION: We describe a 45-year-old woman who was operated on in the sitting position because of a fourth ventricular pilocytic astrocytoma. After surgery, the patient experienced quadriplegia. INTERVENTION: T2-weighted magnetic resonance imaging scans revealed a long, hyperintense area within the cervicothoracic spinal cord that was extended to the lower pons and was consistent with infarction. There was no evidence of previous spine disease. The patient died 6 weeks later of respiratory failure. CONCLUSION: We speculate that alteration of spinal cord blood flow by stretching of the cervical spinal cord and spinal epidural venous engorgement might have caused this devastating complication.