去骨瓣减压术并发症分析

Objective To discuss the surgical complications secondary to decompressive craniectomy as well as the clinical factors related to these complications. Methods We reviewed a series of 83patients undergone surgical decompression and analyzed the incidence of surgical complications as well as the relationship of the complications with GCS score and operation opportunity selection. Results There were 51 patients (61%) with surgical complications after decompression, among whom 30 patients ( 36% ) had more than two kinds of complications. The trauma severity would increase with the incidence of surgical complication, with statistical difference between groups. The late operative group ( ≥ 12hours) showed higher incidence of complication than the early operative group ( < 12 hours), with no statistical difference. Conclusion The procedure of decompressive craniectomy develops kinds of complications which should be prevented, detected and treated early for an optimal prognosis.     

单纯腹部外伤术后发生急性肾功能衰竭的危险因素分析

Objective To investigate the risk factors associated with acute renal failure (ARF)after surgery in patients with simple abdominal trauma. Methods A retrospective case-control study was carried out in patients with simple abdominal trauma after surgery from January 2003 through May 2008 in our hospital. Twenty patients with ARF were set as study group and 68 patients without ARF as control group. Clinical data including age, gender, injury type, number of injured organs, blood transfusion volume, intra-abdominal pressure, abdominal infection, shock and related factors were analyzed by using univariate and Logistic regression to identify the independent risk factors of ARF after surgery in patients with simple abdominal trauma. Results Univariate analysis revealed statistical difference in aspects of blood transfusion volume ( ＞ 1 600 ml), operation timing ( interval between trauma and operation ＞12 h), preoperative shock duration ( ＞6 h), postoperative abdominal infection and intra-abdominal hypertension ( ＞ 12 mm Hg) between two groups ( P ＜ 0. 05 ). Logistic regression analysis showed that these five indices were the independent risk factors of ARF after surgery in patients with simple abdominal trauma ( P ＜ 0. 05 ). Conclusions Massive blood transfusion, delayed operation, long preoperative duration of shock, postoperative abdominal infection or intra-abdominal hypertension are the risk factors of ARF after surgery in patients with simple abdominal trauma. We should pay attention to these factors and take effective measures to prevent occurrence of ARF.     

多发伤合并脊柱脊髓损伤的特点分析

目的 探讨多发伤患者合并脊柱脊髓损伤的临床特点.方法 回顾性分析2004年3月-2009年3月收治的143例合并脊柱脊髓损伤的多发伤患者,统计致伤原因、脊柱损伤节段、合并伤、并发症、治疗方式和转归.结果 高处坠落伤和交通伤是主要致伤原因,分别为77例(53.8%)和55例(38.5%),损伤节段依次为腰椎101处(50.8%)、胸椎61处(30.7%)、颈椎29处(14.6%)及骶尾椎8处(4.0%);合并伤依次为胸部163处(38.6%)、腹部84处(19.9%)、头颈部77处(18.3%)、四肢65处(15.4%)、面部17处(4.0%)和体表16处(3.8%).早期并发症依次为电解质紊乱33例(16.8%)、呼吸系统感染30例(15.3%)和腹胀19例(9.7%);晚期并发症依次为营养不良26例(13.3%)、肌萎缩23例(11.7%)和深静脉血栓11例(5.6%).治疗方式依次为手术治疗106例(74.1%),保守治疗37例(25.9%).治疗前美国脊柱损伤协会(ASIA)评级E级20例(14.0%),治疗后E级53例(37.1%).死亡12例,病死率为8.4%,主要死亡原因为MOF、脑疝、营养衰竭等.随着ASIA残损分级的提高,各组并发症和病死率也显著增加(P＜0.05).结论 高能量损伤是多发伤合并脊柱脊髓损伤的主要致伤因素,患者病情重,合并伤复杂,并发症多,治疗棘手,病死率高.

Abstract：

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in 143 multiple trauma patients combined with spine and spinal cord injuries admitted to our department between March 2004 and March 2009.The parameters including injury cause,segment of injuries,associated injuries,complications,treatment methods and outcomes were analyzed.Results Falling and traffic accidents were the main causes for the injuries of spine and spinal cord,accounting for 53.8%(77 cases)and 38.5%(55 cases),respectively.The injured segments involved 101 lumbar vertebrae(50.8%),61 thoracic vertebrae(30.7%),29 cervical spines(14.6%)and 8 sacrococcygeal vertebrae(4.0%).The associated injuries were located at chest(163 regions,38.6%),abdomen(84 regions,19.9%),head and neck(77 regions,18.3%),extremity(65 regions,15.4%),face(17 regions,4.0%)and body surface(16 regions,3.8%).The early complications included electrolyte disturbances in 33 patients (16.8%),respiratory infection in 30(15.3%)and abdominal distention in 19(9.7%).The late complications were malnutrition in 26 patients(13.3%),amyotrophy in 23(11.7%)and deep vein thrombus in 11(5.6%).Treatment methods were operations and expectant treatments in 106 patients (74.1%)and 37(25.9%)respectively.According to American Spinal Injury Association(ASIA)scale,there were 20 patients(14.0%)at grade E before treatment and 53(37.1%)at grade E after treatment.Of all,12 patients were died of mainly multiple organ failure(MOF),cerebral hernia and malnutrition,with mortality rate of 8.39%.There showed an increase of complication and mortality rate with increase of ASIA grade(P ＜ 0.05).Conclusions The spine and spinal cord injuries in patients with multiple trauma are mainly caused by high energy injuries and characterized by high injury severity,complex associated injuries,multiple complications,difficult management and high mortality rate.     

单纯腹部外伤术后发生急性肾功能衰竭的危险因素分析

Objective To investigate the risk factors associated with acute renal failure (ARF)after surgery in patients with simple abdominal trauma. Methods A retrospective case-control study was carried out in patients with simple abdominal trauma after surgery from January 2003 through May 2008 in our hospital. Twenty patients with ARF were set as study group and 68 patients without ARF as control group. Clinical data including age, gender, injury type, number of injured organs, blood transfusion volume, intra-abdominal pressure, abdominal infection, shock and related factors were analyzed by using univariate and Logistic regression to identify the independent risk factors of ARF after surgery in patients with simple abdominal trauma. Results Univariate analysis revealed statistical difference in aspects of blood transfusion volume ( ＞ 1 600 ml), operation timing ( interval between trauma and operation ＞12 h), preoperative shock duration ( ＞6 h), postoperative abdominal infection and intra-abdominal hypertension ( ＞ 12 mm Hg) between two groups ( P ＜ 0. 05 ). Logistic regression analysis showed that these five indices were the independent risk factors of ARF after surgery in patients with simple abdominal trauma ( P ＜ 0. 05 ). Conclusions Massive blood transfusion, delayed operation, long preoperative duration of shock, postoperative abdominal infection or intra-abdominal hypertension are the risk factors of ARF after surgery in patients with simple abdominal trauma. We should pay attention to these factors and take effective measures to prevent occurrence of ARF.     

重型颅脑损伤患者自主神经功能障碍的临床分析

目的 探讨重型颅脑损伤患者自主神经功能紊乱综合征发生率、临床症状、发病危险因素及预后.方法回顾性分析2008年1月-2010年3月收治的142例重型颅脑损伤患者,比较自主神经功能障碍组和对照组(无自主神经功能障碍患者)的临床特征;采用Logistic回归分析自主神经功能障碍发病的危险因素;伤后6个月采用GOS评分分析其预后.结果142例患者中生存并成功随访94例,自主神经功能障碍患者16例(17%),且其在GCS评分、昏迷时间、ICU时间、平均住院时间等方面较对照组差异有统计学意义(P<0.05);自主神经功能障碍患者预后较差(P<0.05),与弥漫性轴索损伤(DAI)密切相关(OR=11.25,95%CI 7.65～16.54).结论 自主神经功能障碍在严重颅脑损伤患者中发生率较高,临床表现重,DAI增加其发作风险,此类患者多预后不良.

Abstract：

Objective To investigate the incidence, clinical symptoms, correlative risk factors and prognosis of dysautonomia in patients with severe traumatic brain injury. Methods A total of 142patients with severe traumatic brain injury treated from January 2008 to March 2010 were retrospectively surveyed to compare the clinical features of dysautonomia group and control group. Logistic regression was used to analyze the risk factors for dysautonomia. At 6 months post-trauma, the Glasgow Outcome Score (GOS) was used to measure the outcome. Results Of all the patients, 94 patients survived and were followed up. There were 16 patients ( 17% ) diagnosed as dysautonomia depended on clinical symptoms,with statistical difference in aspects of GCS, coma duration, ICU time and average length of stay (ALOS)(P < 0.05). The patients with dysautonomia tended to have poorer outcome ( P < 0.05 ) and showed a positive association with diffuse axonal injury (DAI) ( OR = 11. 25, CI 7.65-16.54 ). Conclusion Dysautonomia has high incidence and is usually severe in patients with severe traumatic brain injury,when DAI may contribute to its occurrence and result in poor prognosis.     

急性颅脑创伤后进展性颅内出血发生的

Objective To investigate the risk factors related to progressive intracranial hemorrhage (PIH) in patients with acute traumatic brain injury (TBI) and analyze their clinical significance.Methods PIH was validated by comparing the initial and repeated CT scans. Data including gender,age, injury causes, Glasgow Coma Score (GCS) on admission, time interval from injury to the first CT scan, initial CT scan manifestations, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), platelet (PLT) and D-dimer (D-D) in both groups were compared with Logistic regression analysis to observe the risk factors related to PIH. Results The study involved 498 patients with acute TBI, of which 139 (27.91%) patients suffered from PIH. There were 116 patients (83.45%) with PIH who received the initial CT scan within two hours post injury.There was statistical difference in aspects of age, GCS on admission, time interval from injury to the first CT scan, initial CT scan manifestations ( including fractures, subarachnoid hematoma, contusion and onset hematoma), PT, Fg and D-D values in both groups (P ＜0.01 ). Logistic regression analysis showed that CT scans (subarachnoid hemorrhage, brain contusion and primary hematoma) and plasma D-D values were predictors of PIH ( P ＜ 0.01 ). Conclusions For patients with the initial CT scan manifestations including subarachnoid hemorrhage, brain contusion, primary hematoma together with D-D value increase within two hours post injury, a continuous CT scan should be performed promptly to detect PIH early.     

急性颅脑创伤后进展性颅内出血发生的

Objective To investigate the risk factors related to progressive intracranial hemorrhage (PIH) in patients with acute traumatic brain injury (TBI) and analyze their clinical significance.Methods PIH was validated by comparing the initial and repeated CT scans. Data including gender,age, injury causes, Glasgow Coma Score (GCS) on admission, time interval from injury to the first CT scan, initial CT scan manifestations, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), platelet (PLT) and D-dimer (D-D) in both groups were compared with Logistic regression analysis to observe the risk factors related to PIH. Results The study involved 498 patients with acute TBI, of which 139 (27.91%) patients suffered from PIH. There were 116 patients (83.45%) with PIH who received the initial CT scan within two hours post injury.There was statistical difference in aspects of age, GCS on admission, time interval from injury to the first CT scan, initial CT scan manifestations ( including fractures, subarachnoid hematoma, contusion and onset hematoma), PT, Fg and D-D values in both groups (P ＜0.01 ). Logistic regression analysis showed that CT scans (subarachnoid hemorrhage, brain contusion and primary hematoma) and plasma D-D values were predictors of PIH ( P ＜ 0.01 ). Conclusions For patients with the initial CT scan manifestations including subarachnoid hemorrhage, brain contusion, primary hematoma together with D-D value increase within two hours post injury, a continuous CT scan should be performed promptly to detect PIH early.     

颈脊髓损伤患者早期死亡的危险因素

目的 探讨创伤性颈脊髓损伤患者早期死亡原因和危险因素.方法回顾性分析553例创伤性颈脊髓损伤患者的临床资料,对影响因素进行单因素分析和多因素Logistic回归分析.结果早期死亡率4.0%(22/553).主要死亡原因为呼吸功能衰竭9例(40.9%)和电解质紊乱5例(22.7%).单因素分析发现年龄、颈脊髓损伤程度、呼吸、心血管和消化系统、电解质紊乱并发症、气管切开与颈脊髓损伤患者早期死亡有一定相关性(P<0.05).多因素Logistic回归分析发现危险因素有年龄、颈脊髓损伤程度、呼吸和心血管系统、电解质紊乱并发症、气管切开.结论 高年龄、颈脊髓损伤程度重、合并呼吸或心血管系统以及电解质紊乱并发症、气管切开是颈脊髓损伤患者早期死亡的高危因素.     

颈椎前路手术中相关神经损伤并发症的常见原因及治疗

目的 回顾颈椎前路手术中相关神经损伤的常见原因及治疗方法.方法 2008年1月-2009年12月手术治疗859例颈椎病、颈椎后纵韧带骨化症及颈椎外伤行颈椎前路手术患者,对术后出现脊髓损伤症状加重及相关神经损伤的7例患者的临床资料进行回顾性分析.结果 859例患者中共5例发生脊髓损伤,发生率为0.58%;1例发生喉返神经损伤,发生率为0.12%;1例发生喉上神经损伤,发生率为0.12%.术后血肿发生脊髓损伤4例,经过清除血肿、甲基强的松龙等药物、高压氧及时治疗,均逐渐恢复至正常;术后发生脊髓损伤症状加重1例,经气管切开、呼吸机支持治疗及激素、高压氧治疗后脊髓损伤症状逐渐恢复至原有水平.术后发生喉返神经、喉上神经损伤患者2例经过激素、脱水等药物保守治疗,术后3个月内均恢复至正常.结论 颈椎病、颈椎后纵韧带骨化症及颈椎外伤患者行颈椎前路手术中均可能发生脊髓损伤及相关神经损伤,如能注意预防和及时治疗,预后较好.

Abstract：

Objective To review the relevant causes for and treatment of nerve injuries in the anterior cervical surgery. Methods From January 2008 to December 2009,859 cages of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma were treated by anterior cervical surgery.This study retrospectively analyzed the clinical data of seven cases who were with worsened symptoms of spinal cord injury and related nerve injury. Results Of 859 cases,five cases(0.58%)were with spinal cord injury,one(0.12%)with recurrent laryngeal nerve injury and one (0.12%)with laryngeal nerve injury.Hematoma occurred in four cases after surgery caused spinal cord injury and all the four patients recovered to normal after removal of the hematoma and timely treatment with mythylprednisolone and hyperbaric oxygen.Cervical spine trauma was worsened in one patient after the anterior cervical surgery.The patient restored to its original level of spinal cord gradually through some measures such as tracheotomy,ventilator support,hormone therapy and hyperbaric oxygen treatment.Laryngeal nerve injuries in two cases recovered to normal after conservative treatment with hormone,dehydration and other drugs within three months after surgery. Conclusions Anterior cervical surgery of cervical spondylosis,ossification of cervical posterior longitudinal ligament and cervical spine trauma are likely to induce the related nerve damage.The good prognosis can be obtained under timely prevention and treatment.     

重型颅脑创伤后脑疝伴失血性休克救治策略

Objective To explore emergency treatment strategies for the patients with brain hernia combined with hemorrhagic shock after severe traumatic brain injury and their effect on prognosis.Methods A retrospective analysis was made on 54 patients (study group) with brain hernia combined with hemorrhagic shock treated with selective treatment strategies from May 2006 to May 2009. Another 48 patients with the same injuries treated with no selective treatment strategies from April 2003 to April 2006 were used as control group. The mortality within one week and the GOS six months after injury were compared in two groups. Results There was no statistical difference in aspects of sex, age, injury mechanism, GCS and blood loss in both groups (P＞0.05). Thirteen patients died in the study group within the first week, with mortality rate of 24.1%. While 16 patients died in the control group at the first week, with mortality rate of 33.3% (P＜0.05). GOS half year after injury in the study group was better than that in the control group (P＜0.05).Conclusion Early selective treatment strategy based on degree of shock may obtain better outcome for patients with brain hernia combined with hemorrhagic shock after severe brain injury.     

颈椎外伤早期死亡的危险因素分析

目的 研究颈椎外伤患者伤后早期死亡的并发症危险因素及其相互关系并探讨对治疗方案的提示.方法 对我院收治的419位颈椎外伤患者出现死亡和并发症的情况进行回顾性分析,研究各种并发症与脊髓损伤严重程度之间的关系、并发症在所有患者和死亡患者中的发生率.结果 呼吸系统并发症是死亡的主要直接原因,占79.41%;死亡前患者中合并有低蛋白血症(85.3%)、低血压(50%)、低钠低氯血症(35.3%)等多种并发症.结论 以低蛋白血症为主的并发症加重了原有功能障碍,成为早期颈椎外伤的死亡危险因素,及时发现并干预能够避免多器官功能衰竭及早期死亡,为康复创造良好条件.     

颈脊髓过伸伤患者退变性因素的分布节段及原因分析

目的研究过伸性颈椎损伤退变程度的相关因素。方法对45例急性过伸性颈椎损伤患者进行回顾分析。所有患者根据影像学和临床查体情况后行改良Frankel分级。根据神经损伤平面结合颈髓髓内高信号征象判定脊髓损伤节段,凡神经平面下整个节段或节段内大部分呈高信号改变者是主要受损脊髓节段,节段内呈现斑片状高信号改变者为一般受损脊髓节段。设计头面部受创、高速运动受创或头面部挫裂较重为重伤力,创伤较轻者为轻伤力。据MRI T2加权椎间盘信号强度判定颈椎间盘退变程度,并进行退变最严重椎间盘分级代表整体颈椎退变分级,轻重程度由0~4级分析外伤力、颈椎退变与受损脊髓节段的关系。结果轻伤者12例,重伤者33例,轻伤组较重伤组脊髓损伤轻、年龄大,组间比较差异具有统计学意义（P〈0.05）。主要受损节段38例共45节,其中C4、5最多;一般受损脊髓节段21例39节。所有患者的颈椎均有明显退变,其中22例发生3级退变,退变严重节段为C5、6。椎间盘处发生退变的受损脊髓节段数为0级无,1级9节,2级20节,3级14节,4级2节。结论外力大小、颈椎节段性退变在颈脊髓过伸性损伤中具有重要作用。     

Incidence of vertebral artery thrombosis in cervical spine trauma: correlation with severity of spinal cord injury

BACKGROUND AND PURPOSE: The incidence of blunt traumatic vertebral artery dissection/thrombosis varies widely in published trauma series and is associated with spinal trauma. The purpose of this study was to determine the frequency of traumatic vertebral artery thrombosis (VAT) in cervically injured patients by using routine MR angiography (MRA) and MR imaging and identify associations with the severity of neurologic injury. METHODS: A retrospective review of 1283 patients with nonpenetrating cervical spine fractures with or without an associated spinal cord injury (SCI) was performed. Imaging consisted of routine cervical MR imaging and 2D time-of-flight MRA of the neck. The cervical injury level, neurologic level of injury, and American Spinal Injury Association (ASIA) grade were recorded. RESULTS: In this study, 632 patients met the inclusion criteria, 83 (13%) of whom had VAT on the admission MR imaging/MRA. Fifty-nine percent (49/83) of VAT patients had an associated SCI. VAT was significantly more common in motor-complete patients (ASIA A and B, 20%) than in neurologically intact (ASIA E, 11%) cervical spine-injured patients (P = .019). VAT incidence was not significantly different between motor-incomplete (ASIA C and D, 10%) and neurologically intact (ASIA E, 11%) cervical spine-injured patients (P = .840). CONCLUSION: The absence of neurologic symptoms in a patient with cervical spine fracture does not preclude VAT. VAT associated with cervical spinal injury occurs with similar frequency in both neurologically intact (ASIA E) and motor-incomplete patients (ASIA C and D) but is significantly more common in motor-complete SCI (ASIA A and B).     

神经外科重危患者气管切开的意义及相关问题探讨(附175例报告)

目的：探讨神经外科重危患者气管切开的意义及指征。方法：175例神经外科重危患者行气管切开术，其中重型颅脑伤117例（66．9％），颅内及高颈段脊髓肿瘤22例（12．6％），高血压脑出血25例（14．3％），其它11例（6．1％）。平均带宽14d，病情好转后套管均直接一次性拔除。结果：治愈好转113例（64．5％），自动出院16例（9．1％），死亡46例（26．3％）。术中无1例发生严重并发症。结论：神经外科重危患者应及时行气管切开，以解除呼吸道梗阻，防止窒息，改善通气，防止加重脑缺氧，防治严重肺部感染，促进神经功能恢复。     

The early evolution of spinal cord lesions on MR imaging following traumatic spinal cord injury

BACKGROUND AND PURPOSE: How early spinal cord injury (SCI) lesions evolve in patients after injury is unknown. The purpose of this study was to characterize the early evolution of spinal cord edema and hemorrhage on MR imaging after acute traumatic SCI.MATERIALS AND METHODS: We performed a retrospective analysis of 48 patients with clinically complete cervical spine injury. Inclusion criteria were the clear documentation of the time of injury and MR imaging before surgical intervention within 72 hours of injury. The length of intramedullary spinal cord edema and hemorrhage was assessed. The correlation between time to imaging and lesion size was determined by multiple regression analysis. Short-interval follow-up MR imaging was also available for a few patients (n = 5), which allowed the direct visualization of changes in spinal cord edema.RESULTS: MR imaging demonstrated cord edema in 100% of patients and cord hemorrhage in 67% of patients. The mean longitudinal length of cord edema was 10.3 ± 4.0 U, and the mean length of cord hemorrhage was 2.6 ± 2.0 U. Increased time to MR imaging correlated to increased spinal cord edema length (P = .002), even after accounting for the influence of other variables. A difference in time to MR imaging of 1.2 days corresponded to an average increase in cord edema by 1 full vertebral level. Hemorrhage length was not affected by time to imaging (P = .825). A temporal increase in the length of spinal cord edema was confirmed in patients with short-interval follow-up MR imaging (P = .003).CONCLUSION: Spinal cord edema increases significantly during the early time period after injury, whereas intramedullary hemorrhage is comparatively static.

Acute traumatic spinal cord injury (SCI) is a devastating event with an incidence of approximately 11,000 injuries in the United States each year.¹ MR imaging is critical to the assessment of acute cervical SCI because it clearly depicts lesion location, extent, and severity. Spinal cord intramedullary edema and hemorrhage are readily appreciated^2,3 and, to some extent, correlate with the clinical neurologic deficit.^4–10 Prior studies have also revealed that both the presence of hemorrhage and increased hematoma length at MR imaging are associated with decreased motor recovery.^7–10Following the immediate structural and neurovascular insult, acute SCI sets into motion a cascade of secondary injuries.^11,12 Work in animals has shown that intramedullary spinal cord hemorrhage and edema are dynamic, whether assessed by histopathology or MR imaging.^13,14The extent to which cord lesions evolve in patients during the early phase of SCI (ie, the first hours and days postinjury) is unknown; therefore, given similar clinical deficits, it is unclear to what extent variability in lesion size reflects differences in time to imaging after trauma. Similarly, it is not clear whether lesion expansion when observed on a short-interval follow-up MR imaging study is an ominous sign or a usual feature in the natural evolution of SCI. This fundamental lack of knowledge is particularly limiting with regard to research aimed at preventing the secondary injury cascade. With an increasing number of therapies for SCI coming to trial, MR imaging can be expected to continue to be increasingly incorporated into research protocols for these agents. An understanding of the acute evolution of SCI lesions on MR imaging is essential if imaging is to be used effectively in these protocols. Additionally, the variability of SCI lesions with time, if demonstrated, would likely have a significant impact on efforts to correlate spinal cord lesion size and location to the neurologic level of injury, because prior studies have not systematically accounted for differences in time to imaging. Such variability currently limits the reliability of MR imaging to serve as an accurate predictor of the patient''s neurologic level and prognosis. This limitation is unfortunate in situations in which the MR imaging findings might be of particular utility, such as in the assessment of the obtunded patients or in patients not undergoing clinical evaluation at a specialized SCI center.To better understand the evolution of SCI lesions, we retrospectively studied how the time interval between trauma and MR imaging affects spinal cord lesion size in patients with similar neurologic deficits. We also directly measured cord edema changes in a small number of patients for whom short-term MR imaging follow-up was available.     

脊柱脊髓损伤救治及进展

脊柱脊髓损伤（ spinal cord injury,SCI）在现代社会中呈高发趋势,其伤情复杂、救治难度大,对患者产生灾难性、危及生命的不幸与后果,家庭背负沉重的负担。在临床的处置中需要进行仔细的病情评估分析、制动、创伤高级生命支持,对有手术指征的患者力争早日手术,最大程度地解除脊髓压迫,减轻继发损伤,促进脊髓康复。     

The relationship between the functional abilities of patients with cervical spinal cord injury and the severity of damage revealed by MR imaging.

BACKGROUND AND PURPOSE: The appearance of the damaged spinal cord after injury correlates with initial neurologic deficit, as determined by the American Spinal Injury Association grade and manual muscle test score, as well as with recovery, as assessed by manual muscle test scores. The purpose of this study was to determine whether the presence of spinal cord hemorrhage and the size and location of spinal cord edema on MR images is predictive of functional recovery in survivors of cervical spinal cord injury (SCI). METHODS: The degree of damage to the cervical spinal cord was measured on the MR images of 49 patients who underwent imaging within 72 hours of sustaining SCI. The effects of hemorrhage and length/location of edema on changes in the value of the motor scale of the functional independence measure (FIM) were assessed on admission to and discharge from rehabilitation. RESULTS: Patients without spinal cord hemorrhage had significant improvement in self-care and mobility scores compared with patients with hemorrhage. There was no significant effect of spinal cord hemorrhage on changes in locomotion and sphincter control scores. The rostral limit of edema positively correlated with admission and discharge self-care scores and with admission mobility and locomotion scores. Edema length had a negative correlation with all FIM scales at admission and discharge. CONCLUSION: The imaging characteristics of cervical SCI (hemorrhage and edema) are related to levels of physical recovery as determined by the FIM scale. Imaging factors that correlate with poor functional recovery are hemorrhage, long segments of edema, and high cervical locations.     

颈髓损伤后气管切开相关因素分析

目的 探讨脊髓损伤后气管切开的危险及预测因素。方法 回顾性分析10年来收治的颈髓损伤患者l064例，按美国脊髓损伤协会（ASIA）神经功能评价标准分为4级，其中A级243例，B级327例，C级306例，D级188例。除外头外伤、气管损伤和来院时已行切开患者7例，共106例患者急性期需要气管切开。评价损伤节段、年龄、吸烟史、既往疾病（糖尿病、高血压、冠心病等）、合并胸部或肺损伤等因素在气管切开的决定作用。结果 本组气管切开率最高为A级患者（35．0％，85／243）；不完全脊髓损伤（B、C和D级）气管切开率只有2．6％（21／814）。A级颈髓损伤中，C3节段损伤3例均需气管切开；C4-5节段损伤患者只占全组的43、2％（105／243），气管切开的患者却占74％（63／85）。脊髓损伤后需气管切开的可能性自C5以下逐渐减少，除了C3水平，C4水平脊髓损伤气管切开的概率最高，与其他节段比较，差异有统计学意义（P〈0．01），而C8节段的脊髓损伤则不需要气管切开。C5-7节段需要气管切开的患者年龄通常〉45岁、患有肺部疾患或者同时合并其他疾病。完全性脊髓损伤中行手术治疗97例，术后无患者需要气管切开，无切口感染发生。结论 完全性、高节段脊髓损伤的患者具有较高的气管切开率。既往肺部疾病、年龄〉45岁是气管切开的危险因素。气管切开不会增加前路手术的感染机会。