60例男性完全性脊髓损伤患者的认知行为筛查

目的:研究完全性脊髓损伤(SCI)患者的认知功能情况以及简易精神状态检查量表(MMSE)和北京版蒙特利尔认知评估量表(MoCA)在完全性SCI患者认知功能障碍筛查中的应用价值。方法:筛选60名男性完全性SCI患者作为研究组,并进一步分为四肢瘫组(22名)和截瘫组(38名);同期招募附近社区30名健康男性作为对照组。对3组用MMSE、北京版MoCA、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估;采用多因素回归分析法对完全性SCI患者的认知功能进行相关性分析。结果:与对照组相比,四肢瘫组及截瘫组的MoCA评分之反向平方根、焦虑和抑郁得分均升高(P<0.05),MoCA的语言项目和延迟回忆项目得分均降低(P<0.05),MMSE评分差异无统计学意义。四肢瘫组与截瘫组对比,上述指标均无显著性差异。多因素回归分析结果显示年龄、文化程度和抑郁与完全性SCI患者MoCA评分显著相关(P<0.05)。结论:年龄、文化程度和抑郁是完全性SCI患者认知功能的影响因素;MoCA量表更适合应用于完全性SCI患者认知功能障碍的初筛。     

急诊创伤性脊柱损伤患者致残程度的相关因素

目的 探讨急诊创伤性脊柱损伤患者致残程度的相关因素.方法 自行设计《创伤性脊柱损伤致残因素调查表》并结合《脊柱脊髓损伤评分》,对创伤性脊柱损伤患者285例进行调查评估.结果 创伤性脊柱损伤患者中有昏迷情况患者A级57例,B级37例,C级44例,D级17例,E级18例,与无昏迷患者损伤程度比较差异有统计学意义（Z=20.055,P＜0.01）;不同运送方式、创伤原因、脊柱手术时间患者脊髓损伤程度不同,差异均有统计学意义（P＜0.05）;在创伤性脊柱损伤中主要是车祸、打砸和坠落伤.结论 除创伤直接因素外,影响创伤性脊柱损伤患者损伤水平还包括现场及运送患者保护不当、昏迷患者救治措施以抢救生命为主、转运增加二次运送风险、延误早期手术时间.     

儿童及青少年脊柱脊髓损伤特征

目的:了解儿童及青少年脊柱脊髓损伤的特殊性,分析受伤原因及诊治要点。方法:调查分析于1992/2002在北京博爱医院脊柱脊髓外科完成。统计实验期间所收治的儿童及青少年脊柱脊髓损伤患者50例。颈椎损伤13例,胸椎损伤9例,胸腰椎损伤12例,腰椎损伤4例;无骨折脱位型脊髓损伤12例(颈髓3例,胸髓8例,不详1例);其中无脊髓损伤的颈椎损伤1例。在神经系统损伤的49例中,颈髓14例,胸髓20例,圆锥及(或)马尾神经14例,不详1例;完全性损伤23例,完全性损伤转变为不完全性损伤2例,不完全性损伤23例,不详1例。结果:50例脊柱脊髓损伤患者纳入结果分析。脊髓完全性损伤的23例中,有改善的7例,无明显改善的16例;在不完全性损伤的23例中,有改善的14例,无明显改善的9例。在前路手术治疗中,颈椎7例,胸腰椎3例;后路手术中,颈椎3例,胸椎7例,胸腰椎9例,腰骶椎2例。在手术的31例中,神经功能有改善9例,无明显改善22例;在未手术19例中,神经功能有改善9例,无明显改善8例,不详2例。与汽车有关的交通肇事伤17例。受伤原因中因交通事故、坠落伤和运动损伤较其他原因有显著性差异(P<0.05)。脊髓损伤功能恢复上,完全性与不完全性损伤无显著性差异(P>0.05);手术与非手术对脊髓损伤恢复上,差异无显著性意义(P>0.05)。结论:儿童及青少年脊柱脊髓损伤受伤原因以交通事故、坠落伤和运动损伤为主,脊髓功能恢复也有其特殊性。     

脊髓损伤的康复流程及其应用

脊髓损伤的康复流程及其应用汪土松１施康能２脊髓损伤（ｓｐｉｎａｌｃｏｒｄｉｎｊｕｒｙ，ＳＣＩ）往往造成不同程度的四肢瘫或截瘫，是一种严重致残性的创伤。致伤原因很多，如高处坠落、车祸、暴力打击或砸伤、体育运动、刀伤或枪伤等。脊髓损伤患者的康复应从受伤现...     

脊髓损伤病人轮椅期安全管理

脊髓损伤(Spinal Cord Injury SCI)是一种严重的致残性损伤,它可造成截瘫或四肢瘫.完全性脊髓损伤患者生命虽得到救治,但损伤平面以下的运动、感觉的丧失却是终身,常常需要依靠轮椅进行日常生活活动.     

针刺治疗脊髓损伤20例观察报告

1 资料与方法 20例患者均为 1992年以来我院住院的外伤性截瘫病人。入院时,脊椎骨折、脱位已愈合整复,其中 13人受伤后行减压固定手术治疗,都有不同程度截瘫。 20例患者中男 14例,女 6例。年龄 20～ 30岁。损伤：颈椎 3例、胸椎 6例、腰椎 11例。不完全性截瘫 17例,完全性截瘫 3例。病程 42d～ 4年。治疗方法：以针灸为主。四肢瘫：确定颈椎损伤平面后,在其头、尾两端进针,再选肩骨禺、臂月需、曲池、手三里、外关、合谷等。截瘫：脊髓损伤的头尾两端,环跳、殷门、委中、承山、三阴交、髀关、血海、风市、瘫立、足三里、解溪。膀胱…     

外伤性致瘫患者的康复护理

我国外伤性致瘫者多为交通事故、建筑事故、暴力等引起，多造成脊髓损伤致严重瘫痪。脊髓损伤后引起受伤平面以下双侧肢体感觉、运动、反射等消失和膀胱、肛门括约肌功能完全或部分丧失称截瘫。颈髓C4以上损伤上肢受累则称四肢瘫。据资料显示，在美国，每年仅因创伤而发生的急性脊髓损伤约8000～10000例，最常见的原因是车祸、坠落伤和火器伤。     

脊髓损伤病人综合膀胱功能训练的效果观察

脊髓损伤是脊柱损伤后的严重并发症,由于椎体骨折脱位,移位的椎体向后或骨片突入椎管,可压迫脊髓或马尾神经,产生不同程度的损伤。受伤平面以下的感觉、运动、反射完全消失,括约肌功能完全丧失,称完全性截瘫,部分丧失时称不完全截瘫[1],两者均可导致膀胱和排尿功能障碍,病人因尿潴留而需在一段时间内留置尿管。我科自2005年以来,对脊髓损伤病人进     

截瘫50例并发症的预防及健康教育

创伤性截瘫大多是由于暴力致脊柱骨折、脱位所致,脊髓损伤后导致受伤脊髓平面以下肢体的感觉、运动、反射完全或部分消失,括约肌功能完全丧失[1],引起二便失禁、四肢活动障碍、植物神经系统功能障碍等。截瘫患者病程长,易导致多系统严重并发症,如压疮、泌尿系统感染、肺部感染、肌肉萎缩等,并发症不仅影响疗效,严重的甚至危及生命。因此,有计划地进行健康教育,可以提高生活质量,有效预防并发症。1临床资料1.1一般资料本组脊柱骨折合并截瘫患者50例,男42例,女8例,年龄18~62(平均48)岁。受伤原因:从高处坠落6例,车祸受伤30例,重物砸伤14例。受伤部位:颈椎骨折13例,胸椎骨折11例,腰椎骨折26例。其中完全性截瘫24例,不完全性截瘫26例。1.2方法以患者及其家属为健康教育的对象,采取个别教育和集体教育相结合的方法。首先对患者及家庭作一个评估,详细了解患者家庭情况、文化程度、生活环境、生活习惯、经济情况等,并由此制定教育计划及内容。健康教育针对护理患者的家庭主要成员进行,采取全面指导,突出重点、以点带面等方法。必要时对全体家庭成员集中进行教育以提高效果。注重根据其文化程度分别以书面、语言和示范等方法进行教育。对文化程...     

截瘫的护理

由于某种原因,造成横贯性脊髓损伤,而引起损伤平面以下不同程度的感觉、运动功能障碍谓截瘫。根据截瘫平面的高低可分为高位截瘫(脊髓颈段、上胸段)和低位截瘫(脊髓下胸段、腰段损伤)根据截瘫的原因又可分为病理性截瘫(脊髓炎症、肿瘤、脊柱结核等)和外伤性截瘫。引起截瘫的原因很多,根     

人格特质与脑外伤偏瘫患者残障接受度的相关性研究

目的：了解脑外伤患者的人格特质和残障接受度现状,并探讨两者的相关性,为改善脑外伤患者残障接受度提供参考。方法：采用艾森克人格问卷简式量表（中国版）和残障接受度量表对209例脑外伤患者进行问卷调查,比较不同残障接受度患者人格特质的差别,并采用Pearson相关分析法探讨两者的相关性。结果：脑外伤患者残障接受度总分为（160.11±34.58）分,其中低接受度占29.19%,中接受度占54.07%,高接受度占16.74%。本研究209例脑外伤患者精神质、神经质、掩饰性评分显著高于中国常模（均P＜0.01）,内外向评分显著低于中国常模（均P＜0.01）。不同接受度组的精神质、内外向、神经质和掩饰性评分比较,差异均有统计学意义（均P＜0.05）。脑外伤患者残障接受度总分及各维度得分与人格特质中的精神质、神经质和掩饰性均显著负相关（均P＜0.05）;残障接受度总分及各维度得分与人格特质中的内外向显著正相关（均P＜0.05）。结论： 脑外伤患者残障接受度处于中等偏下水平,人格特质与其残障接受度密切相关,可从人格特质入手改善脑外伤患者的残障接受度。     

Pain-related fear in low back pain: a prospective study in the general population.

A cognitive behavioural account of chronic low back pain (CLBP) proposes that the relationship between pain catastrophizing and functional disability is mediated by fear of movement/(re)injury. Several clinical studies already demonstrated the contribution of pain catastrophizing and fear of movement/(re)injury in the development and maintenance of CLBP. This study included people with low back pain (LBP) in the general population, and aimed to investigate whether fear of movement/(re)injury mediated the relationship between pain catastrophizing and functional disability, by examining several prerequisites for mediation. Data from the Dutch population-based Musculoskeletal Complaints and Consequences Cohort (DMC(3)) study were used, including 152 people suffering from LBP who completed both a follow-up questionnaire and a baseline questionnaire 6 months previously. This study was unable to demonstrate that the relationship between pain catastrophizing and functional disability was mediated by fear of movement/(re)injury, since the prerequisite that pain catastrophizing and functional disability were related, was not fulfilled. However, pain catastrophizing was significantly related to fear of movement/(re)injury 6 months later, above and beyond other contributing variables such as fear of movement/(re)injury already present at baseline. On its turn, fear of movement/(re)injury was related to functional disability, in addition to pain intensity. Although this study leaves some indistinctness concerning the actual relationships between pain catastrophizing, fear of movement/(re)injury, and functional disability, it does provide some evidence for the contributing role of these factors in LBP in the general population.     

Predicting perceived recovered activity in older people after a fall

Purpose: Fall injury represents a common cause of disability in older people. Much research in this area ignores the importance of psycho-social factors in recovery from a fall. Method: Data were collected from a sample of 40 people ( 65 years) admitted to hospital as a result of a fall. Details included: the fall event; causal beliefs; psychological impact; history of falls; pre-fall activity; general health; and beliefs concerning recovery, including efficacy and affective beliefs. After 2 months, participants were recontacted by letter and completed a questionnaire assessing perceived residual levels of disability (65% response). Results: Results indicated that beliefs that the fall was due to external causes and was preventable were each associated with higher perceived recovered activity, even when controlling for pre-fall activity, health status and fall injury. Conclusion: The implications of these findings are discussed with regard to promoting recovery after a fall in older people.     

The prevalence of disability from chronic conditions due to injury among adults ages 18-69 years: United States, 1994

Purpose: To describe the causes and determine the prevalence of disability from chronic conditions due to injury among US civilian non-institutionalized persons aged 18-69 years. Methods: Data from the National Health Interview Survey Disability (NHIS-D) Supplement Phase I, United States 1994 were analysed and six disability categories were examined: activities of daily living (ADL), instrumental activities of daily living (IADL), functional activities (FA), sight, hearing, and communication. Results: In 1994, 5.6 million persons aged 18-69 years reported a disability because of a chronic condition that was caused by injury. The prevalence of ADL disability due to chronic conditions caused by injury was 370 per 100000 population; IADL disability was 1256; FA disability was 2512; sight was 231; hearing was 339; and communication was 91 per 100000 population. Fifty per cent of ADL, IADL, and FA disabilities were attributed to motor vehicle crashes and falls, as were 31% of sight, 19% of hearing, and 23% of communication disabilities. Conclusions: Though these estimates may be conservative, this study indicates that injury is a major cause of disability in addition to a leading cause of death in the US.     

The prevalence of disability from chronic conditions due to injury among adults ages 18-69 years: United States, 1994

Purpose: To describe the causes and determine the prevalence of disability from chronic conditions due to injury among US civilian non-institutionalized persons aged 18-69 years. Methods: Data from the National Health Interview Survey Disability (NHIS-D) Supplement Phase I, United States 1994 were analysed and six disability categories were examined: activities of daily living (ADL), instrumental activities of daily living (IADL), functional activities (FA), sight, hearing, and communication. Results: In 1994, 5.6 million persons aged 18-69 years reported a disability because of a chronic condition that was caused by injury. The prevalence of ADL disability due to chronic conditions caused by injury was 370 per 100000 population; IADL disability was 1256; FA disability was 2512; sight was 231; hearing was 339; and communication was 91 per 100000 population. Fifty per cent of ADL, IADL, and FA disabilities were attributed to motor vehicle crashes and falls, as were 31% of sight, 19% of hearing, and 23% of communication disabilities. Conclusions: Though these estimates may be conservative, this study indicates that injury is a major cause of disability in addition to a leading cause of death in the US.     

Health-related quality of life and disability in survivors of multiple trauma one year after intensive care unit discharge

OBJECTIVE: To evaluate health-related quality of life and disability in multiple-trauma patients requiring intensive care unit management. DESIGN: A total of 87 survivors of multiple trauma, with a median age of 31 yrs and a median Injury Severity Score of 22, were enrolled in the present study. The Nottingham Health Profile, Glasgow Outcome Scale, and Rosser Disability Scale were used to assess the functional consequences of trauma 1 yr after intensive care unit discharge. RESULTS: A total of 64 of 87 patients had a problem in at least one of the six domains related to subjective health status. The most prevalent complaint was related to somatic subdimensions, but emotional functioning was also affected. Nottingham Health Profile part 2 showed that 63 of the survivors experienced problems in at least one of the daily activities. Of particular importance, inability to work was reported by 47% of the patients. Fifty-nine percent experienced moderate-to-severe disability as evaluated by Glasgow Outcome Scale and Rosser Disability Scale. High aggregate injury severity score along with severe head trauma were independent predictors of poor health-related quality of life and disability. CONCLUSIONS: The majority of survivors of major trauma exhibit considerable levels of disability and impairment in health-related quality of life. Global injury severity score and degree of brain trauma determine functional limitations. This information may help in organizing long-term rehabilitation of multiple-trauma patients.     

Injury among 1107 Canadian students with self-identified disabilities

PURPOSE: Students with disabilities are at risk for poor health outcomes; however, the causes and consequences of injury in this group are not well understood. The epidemiologies of injuries among students with and without disabilities were profiled and compared. METHODS: The cross-sectional, 2002 Health Behaviour in School-aged Children Survey, was administered to a representative sample of 7235 students (grades 6-10) from Canada. Students who reported at least one functional difficulty due to a health condition were classified as having a disability. Primary outcomes were: (i) Medically attended injury; (ii) multiple injuries, and (iii) serious injury experiences during a 12-month period. RESULTS: Some 16.3% of students reported a disability. Injuries were more common in students with disabilities compared to those without disabilities (67% vs. 51% annually, p < 0.01). Students with disabilities experienced 30% increases in the risk for medically attended injury, multiple injury, and serious injury as compared to their peers. Consistent and statistically significant associations (p < 0.05) were identified between different types of disability and all injury outcomes. CONCLUSIONS: Canadian students who report disabilities experience higher risks for injury than their peers, perhaps due to an inability to perceive and avoid environmental hazards. Injury prevention programmes are needed to address these unique risk profiles in order to prevent additional disability or secondary conditions.     

Derivation of a clinical prediction rule to identify both chronic moderate/severe disability and full recovery following whiplash injury

Recovery following a whiplash injury is varied: approximately 50% of individuals fully recover, 25% develop persistent moderate/severe pain and disability, and 25% experience milder levels of disability. Identification of individuals likely to develop moderate/severe disability or to fully recover may help direct therapeutic resources and optimise treatment. A clinical prediction rule (CPR) is a research-generated tool used to predict outcomes such as likelihood of developing moderate/severe disability or experiencing full recovery from whiplash injury. The purpose of this study was to assess the plausibility of developing a CPR. Participants from 2 prospective, longitudinal studies that examined prognostic factors for poor functional recovery following whiplash injury were used to derive this tool. Eight factors, previously identified as predictor variables of poor recovery, were included in the analyses: initial neck disability index (NDI), initial neck pain (visual analogue scale), cold pain threshold, range of neck movement, age, gender, presence of headache, and posttraumatic stress symptoms (Posttraumatic Diagnostic Scale [PDS]). An increased probability of developing chronic moderate/severe disability was predicted in the presence of older age and initially higher levels of NDI and hyperarousal symptoms (PDS) (positive predictive value [PPV] = 71%). The probability of full recovery was increased in younger individuals with initially lower levels of neck disability (PPV = 71%). This study provides initial evidence for a CPR to predict both chronic moderate/severe disability and full recovery following a whiplash injury. Further research is needed to validate the tool, determine the acceptability of the proposed CPR by practitioners, and assess the impact of inclusion in practice.