创伤性脊髓损伤患者的流行病学及住院费用影响因素研究

目的:分析创伤性脊髓损伤(SCI)患者的流行病学特征,评价创伤性SCI患者的住院费用,探索影响住院费用的因素。方法:收集中国康复研究中心收治的252例创伤性SCI患者流行病学相关数据,并采用描述性分析患者基本信息、损伤情况、并发症、住院时间、费用及支付方式,单因素分析和多元线性回归模型分析患者基本特征对住院费用的影响。结果:共252例患者,男女比为4.1:1,41~60岁的患者占比最大(37.3%),工人在患者中占比最大(26.2%);致伤原因中交通事故占首位(26.4%),其次为高空坠落(25.5%);颈段SCI患者占首位(47.2%),其次为胸段(43.3%);ASIA评分A级患者为主(48%),其次为D级患者(22.6%);并发症中发病率前3位分别是神经痛(44.4%)、泌尿系感染(23.8%)、痉挛(22.6%);医疗保险就医患者(34.9%),工伤保险患者(18.7%),其余为自费医疗患者(46.4%)。手术等级、并发症数量、合并症情况、损伤节段、损伤程度、伤后时间间隔的组间差距均影响康复费用;手术等级、并发症数量、受伤时间、损伤节段是康复费用的主要影响因素。结论:男性在SCI患者中的占比升高,颈段SCI患者占比增大;应注意行车和施工中的安全防护,遵守交通法规和操作流程,高龄人群应预防跌倒的发生。医疗保险制度不断完善,减轻了脊髓损伤患者的经济负担。受伤时间对日均住院费用影响最大,其次为手术等级、并发症数量和损伤节段,为合理配置医疗资源可考虑从这几方面着手。     

630例颈髓损伤住院患者流行病学特征分析

目的总结630例颈髓损伤住院患者的流行病学特征。方法回顾性分析2014年1月至2019年10月我院收治的630例颈髓损伤患者的临床资料,对患者的性别、年龄、职业、致伤原因、损伤部位及程度、并发症、死亡人数及原因等进行统计学处理。结果630例患者中男514例,女116例,男女比为4.43∶1;平均年龄(52.04±14.33)岁,高发年龄段为40~69岁。按职业分布颈髓损伤最多的依次为农民(53.65%)、司机(15.71%)和工人(14.13%)。车祸伤(35.40%)和坠落伤(33.81%)是主要的致伤原因。在颈髓损伤患者中ASIA评分等级多为A级(41.59%),且C5~C8颈髓损伤概率较高(66.03%)。本组患者中共有310例发生并发症,排在前3位的依次为便秘(76.45%)、下肢深静脉血栓(65.16%)和低钠血症(37.42%)。颈椎损伤患者的病死率为4.92%。630例患者中新型农村合作医疗281例(44.61%),全自费55例(24.60%)。结论本研究调查分析颈髓损伤患者的流行病学特征,为今后颈髓损伤的治疗和护理提供了理论依据,对促进患者康复、提高生活质量及生存寿命具有重要意义。     

Traumatic brain injury is under-diagnosed in patients with spinal cord injury.

OBJECTIVE: To investigate the occurrence and severity of traumatic brain injury in patients with traumatic spinal cord injury. DESIGN: Cross-sectional study with prospective neurological, neuropsychological and neuroradiological examinations and retrospective medical record review. PATIENTS: Thirty-one consecutive, traumatic spinal cord injury patients on their first post-acute rehabilitation period in a national rehabilitation centre. METHODS: The American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury were applied. Assessments were performed with neurological and neuropsychological examinations and magnetic resonance imaging 1.5T. RESULTS: Twenty-three of the 31 patients with spinal cord injury (74%) met the diagnostic criteria for traumatic brain injury. Nineteen patients had sustained a loss of consciousness or post-traumatic amnesia. Four patients had a focal neurological finding and 21 had neuropsychological findings apparently due to traumatic brain injury. Trauma-related magnetic resonance imaging abnormalities were detected in 10 patients. Traumatic brain injury was classified as moderate or severe in 17 patients and mild in 6 patients. CONCLUSION: The results suggest a high frequency of traumatic brain injury in patients with traumatic spinal cord injury, and stress a special diagnostic issue to be considered in this patient group.     

Early unplanned transfers from inpatient rehabilitation

OBJECTIVE: To identify characteristics of patients who transfer off inpatient rehabilitation to a surgical or medical unit before completion of their rehabilitation program. DESIGN: A retrospective 9-yr chart review of patients transferred off the rehabilitation unit at a regional level 1 trauma center due to medical complications. RESULTS: Of 3072 patient admissions, 250 (8%) were transferred to an acute medical or surgical unit, and 55 (22%) of those transfers were within 3 days. Of the 250 patients, 33% had traumatic brain injury, 23% had spinal cord injury, 24% had stroke, 2% had amputations, 18% were in other diagnostic groups, and 23% were >64 yrs of age. When patients transferred early, only 47% were ultimately discharged to home, compared with approximately 72% of all discharges. The most common reasons for early transfer in these patients were infection (22%) and pulmonary complications (14%). Risk factors for early discharge included age of >64 yrs, spinal cord injury, or amputation. CONCLUSION: Patients admitted to the inpatient rehabilitation unit who have spinal cord injuries, amputations, or are >64 yrs old may have more medical/surgical complications. More detailed study of this patient population may help reduce the number of early transfers off the inpatient rehabilitation unit.     

Duplex ultrasound screening for deep vein thrombosis in spinal cord injured patients at rehabilitation admission.

OBJECTIVE: To determine the rate of deep vein thrombosis (DVT) newly diagnosed by duplex ultrasound in patients with acute spinal cord injury (SCI) at admission for rehabilitation. DESIGN: Retrospective case-control study. SETTING: Independent specialized spinal cord rehabilitation hospital. PATIENTS: Data were collected from records of 189 SCI patients admitted for rehabilitation over a 1-year period who underwent a duplex scan and were not admitted with a known diagnosis of DVT. MAIN OUTCOME MEASURES: A DVT newly diagnosed by duplex ultrasound at rehabilitation admission. RESULTS: Twenty-two patients (11.6%) had a newly diagnosed DVT at time of admission. Chi-square analysis found no statistically significant relationship between level of injury (tetraplegia vs paraplegia), motor complete (ASIA A and B) versus incomplete status (ASIA C and D), or cause of SCI (traumatic vs nontraumatic injury) in determining a positive or negative duplex result (chi2 = 1.709, p = .191; chi2 = 1.314, p = .252; chi2 = 3.155, p = .076; respectively). Prophylaxis for DVT decreased the risk of developing a DVT: 4.1% of patients administered prophylaxis as compared to 16.4% of patients not given prophylaxis (chi2 = 6.558, p = .01). Only 38.6% of patients transferred to rehabilitation were undergoing DVT prophylaxis. CONCLUSIONS: The prevalence of DVT in acute SCI patients at admission to rehabilitation is significant. A duplex ultrasound is an important noninvasive technique to screen patients with acute and subacute SCI for DVT on admission to the rehabilitation setting regardless of the completeness, level, or cause of the patients' injury.     

Predictors of dysphagia after spinal cord injury.

OBJECTIVE: To quantify the incidence of swallowing deficits (dysphagia) and to identify factors that predict risk for dysphagia in the rehabilitation setting following acute traumatic spinal cord injury. DESIGN: Retrospective case-control study. SETTING: Freestanding rehabilitation hospital. PATIENTS: Data were collected on 187 patients with acute traumatic spinal cord injury admitted for rehabilitation over a 4-year period who underwent a swallowing screen, in which 42 underwent a videofluoroscopic swallowing study (VFSS). MAIN OUTCOME MEASURES: VFSS was performed on patients with suspected swallowing problems. Possible antecedents of dysphagia were recorded from the medical record including previous history of spine surgery, surgical approach and technique, tracheostomy and ventilator status, neurologic level of injury, ASIA Impairment Classification, orthosis, etiology of injury, age, and gender. RESULTS: On admission to rehabilitation 22.5% (n = 42) of spinal cord injury patients had symptoms suggesting dysphagia. In 73.8% (n = 31) of these cases, testing confirmed dysphagia (aspiration or requiring a modified diet), while VFSS ruled out dysphagia in 26.2% (n = 11) cases. Logistic regression and other analyses revealed three significant predictors of risk for dysphagia: age (p < .028), tracheostomy and mechanical ventilation (p < .001), and spinal surgery via an anterior cervical approach (p < .016). Other variables analyzed had no relation or at best a slight relation to dysphagia. Tracheostomy at admission was the strongest predictor of dysphagia. The combination of tracheostomy at rehabilitation admission and anterior surgical approach had an extremely high rate of dysphagia (48%). CONCLUSION: Swallowing abnormalities are present in a significant percentage of patients presenting to rehabilitation with acute traumatic cervical spinal cord injury. Patients with a tracheostomy appear to have a substantially increased risk of development of dysphagia, although other factors are also relevant. Risk of dysphagia should be evaluated to decrease the potential for morbidity related to swallowing abnormalities.     

Rehabilitation for patients with paraplegia and lower extremity amputation

[Purpose] To study the characteristics and treatment strategy for patients with paraplegia and lower extremity amputation. [Subjects] Six cases were selected from among the patients admitted to the China Rehabilitation Research Center from 1991 to 2014. The criteria for the six cases were spinal cord injury with amputation immediately or in a short time (1 week) after the trauma. [Methods] General information, clinical diagnosis, treatment, rehabilitation and other data were analyzed. [Results] All the six cases were injured by high energy or complex energy accidents: two cases by falls after high voltage electric shock, one by an oil pipeline explosion, one by the impact of a falling tower crane and received high energy traffic accident injuries (one was hit by a train, and the other was hit by a truck at high speed). All the six cases had thoracic and lumbar vertebral injuries and complete paraplegia. Amputation stump infection occurred in four cases. After comprehensive rehabilitation treatment, patients’ functional independence measure (FIM) scores improved significantly, but American Spinal Injury Association (ASIA) scores and ASIA Impairment Scale (AIS) grades showed no significant improvement. [Conclusion] When formulating the clinical treatment and rehabilitation for spinal cord injury with amputation patients, simultaneous consideration of the characteristics of the spinal cord injury and amputation is needed to develop an individualized strategy. For spinal cord injury with limb amputation patients, prostheses should allow the improvement of patients’ self-care ability.Key words: Paraplegia, Amputation, Rehabilitation     

脊髓损伤患者康复护理数据网络平台的建设

目的：建设一个应用于脊髓损伤患者康复护理数据收集平台,为建立脊髓损伤患者规范化的护理流程与指引提供数据。方法采用回顾性分析我科4年时间的患者资料及国内外对脊髓损伤患者的康复护理进展,确定平台系统的收集数据的项目并开发数据平台软件。结果开发脊髓损伤患者康复数据网络平台软件1套,并应用于临床进行数据收集。结论脊髓损伤康复护理数据网络平台的应用,通过各项护理数据的收集与分析,使护理成效评价由经验式转变到客观数据评价,为循证护理提供科学依据。     

Functional improvement after pediatric spinal cord injury

OBJECTIVE: To describe the functional gain (FGain) with pediatric spinal cord injury inpatient rehabilitation and to identify the relationship of various factors to FGain in pediatric spinal cord injury inpatient rehabilitation. DESIGN: Retrospective chart review of a series of 91 children with spinal cord injury admitted from 1993 to 1998 in a freestanding rehabilitation hospital. Admission and discharge functional status were assessed with the Pediatric Functional Independence Measure (WeeFIM) instrument for children 7 yr. The outcome measure is the FGain (difference between the discharge and admission functional status). RESULTS: Significant gains in functional status were observed in all patients. FGain was not significantly related to age, sex, length of inpatient rehabilitation, pathogenesis, or completeness or neurologic level of injury. However, there was a trend for higher FGain for patients with incomplete spinal cord injury and traumatic spinal cord injury. CONCLUSIONS: Functional improvement occurs with pediatric spinal cord injury inpatient rehabilitation. There is a trend for higher FGain in patients with less severe injury and traumatic injury. The lack of relationship between FGain and length of inpatient rehabilitation suggests that a variety of other factors influence the relationship between FGain and length of inpatient rehabilitation.     

Characteristics and rehabilitation for patients with spinal cord stab injury

[Purpose] The objective of the study was to compare the incidence, diagnosis, treatment, and prognosis of patients with spinal cord stab injury to those with the more common spinal cord contusion injury. [Subjects] Of patients hospitalized in China Rehabilitation Research Center from 1994 to 2014, 40 of those having a spinal cord stab injury and 50 with spinal cord contusion were selected. [Methods] The data of all patients were analyzed retrospectively. The cases were evaluated by collecting admission and discharge ASIA (American Spinal Injury Association) and ADL (activity of daily living) scores. [Results] After a comprehensive rehabilitation program, ASIA and ADL scores of patients having both spinal cord stab injury and spinal cord contusion significantly increase. However, the increases were noted to be higher in patients having a spinal cord stab injury than those having spinal cord contusion. [Conclusion] Comprehensive rehabilitation is effective both for patients having spinal cord stab injury and those with spinal cord contusion injury. However, the prognosis of patients having spinal cord stab injury is better than that of patients with spinal cord contusion.Key words: Spinal cord injury, Stab injury, Rehabilitation     

The epidemiology of migraine: a retrospective study in Italian emergency departments

This study was conducted to measure the frequency of contact with emergency departments in Italy because of migraine, and to compare the initial diagnosi s of headache with the diagnosis after application of the International Headache Society (IHS) criteria. A retrospective observational method was used, consisting of an analysis of the records of patients admitted to nine Italian emergency departments during different 4-month periods in 1994. Comparison of the initial diagnosis with the diagnosis after application of the IHS diagnostic criteria was performed. More than 31 million emergency department contacts were reported in Italy during 1994. In the same year, 543 630 patients visited the nine emergency departments enrolled in the study, with 169 569 of these contacts occurring in the 4-month period analyzed in the study. We excluded from the analysis all cases of secondary headache fully recognized at the emergency department admission (ie, traumas, intracranial pathology, systemic diseases). The total number of patients included in our analysis was 1043 (0.6%). The 934 patients who could be fully evaluated were initially classified as having migraine; cluster headache; headache not otherwise specified; or diagnosed in the emergency department as suffering from headache, but reclassified by other departments as suffering from a different disease. After retrospective application of the IHS classification, the diagnostic distribution was modified, revealing that 18% of patients with migraine and 5% with cluster headaches had previously been classified as having headache not otherwise specified; a further 6% of cases with migraine and 0.4% of patients with cluster headache had previously been classified as having secondary headaches. The diagnosis of headache not otherwise specified was made with notable frequency, indicating the limits of emergency department logs and the difficulty in carrying out a retrospective analysis and reassessment of diagnosis. The majority (88%) of patients assessed had not taken drugs for headache in the 48 hours before the emergency department contact, suggesting that in Italy emergency departments are used instead of a visit to the general practitioner. Nonsteroidal anti-inflammatory drugs were the most frequently prescribed drugs in the emergency departments for this group of diagnoses. The research revealed, on the one hand, that headache is a numerically significant phenomenon in the emergency department setting and, on the other, the need to apply prospective designs to this kind of survey.     

Evolving risk for thromboembolism in spinal cord injury (SPIRATE Study)

OBJECTIVE: To compare the frequency of venous thromboembolism (VTE) in patients examined during 1992-1995 with those examined during 1999-2003. DESIGN: A comprehensive review of the charts of all patients admitted between late 1999 and early 2003 for rehabilitation after spinal cord injury. Only records, including evidence for objective testing for VTE (ultrasound, venography, lung scanning) were included, and patients having inferior vena cava filter placement or previous VTE were excluded. Analysis variables included type and location of spinal cord injury, American Spinal Injury Association classification, concomitant injuries, surgical procedures, complications, preexisting illnesses, and use of antithrombotic prophylaxis. Using univariate optimal discriminant analysis, data from the current group of patients were compared with a previous study of 243 subjects examined between 1992 and 1995. RESULTS: The current sample consisted of 76 persons with acute spinal cord injury, of whom six had VTE (7.9%). As compared with the frequency of VTE in the previous patient sample (21%), this represented a significant decrease (P<0.01). The major differences between the current and previous patient samples were a decrease in the use of unfractionated heparin (15.8% vs. 56.8%, P<0.0001) and an increase in the use of low molecular weight heparin (81.6% vs. 59.7%, P<0.0001). CONCLUSIONS: VTE has been a common and occasionally lethal complication in persons with spinal cord injury. The recent switch from unfractionated heparin to low molecular weight heparin for the prevention of VTE has coincided with a decrease in the frequency of this complication in patients with spinal cord injury.     

Cost-effectiveness of duplex ultrasound surveillance in spinal cord injury

OBJECTIVE: To determine cost-effectiveness of surveillance with duplex ultrasound for thromboembolic disease in individuals with acute traumatic spinal cord injury at admission to rehabilitation. DESIGN: In this retrospective sequential case series study, individuals with traumatic spinal cord injury admitted to our rehabilitation facility between July 1, 1988, and December 31, 1998, were identified. Cost at our institution for treatment of thromboembolic disease was tabulated in 2001-2002 dollar amounts. Using this cost information, in a statistical model founded on available medical evidence, analysis for cost-effectiveness was then performed. RESULTS: A total of 369 subjects met inclusion criteria. Based on the statistical model, the cost and estimated mortality from thromboembolic disease per subject when performing admission duplex ultrasounds was $449.28 and 0.016%, respectively. The estimated total cost per subject when not performing admission duplex ultrasounds was $136.29, with predicted mortality of 0.524% due to thromboembolic disease. Therefore, cost of one life saved when performing admission duplex ultrasound surveillance is calculated to be $61,542, with cost per life year gained between $1193 and $9050, depending on age at time of injury and severity of injury. CONCLUSION: Duplex ultrasound is a cost-effective tool for deep venous thrombosis surveillance in individuals with acute traumatic spinal cord injury admitted to rehabilitation programs.     

康复护理在颈脊髓损伤伴有呼吸功能障碍患者中的干预效果

目的研究康复护理在颈脊髓损伤伴有呼吸功能障碍患者中的干预效果。方法选取2016年10月至2018年10月我院收治的52例颈脊髓损伤伴呼吸功能障碍患者作为研究对象,随机分为对照组(26例,常规护理干预)和观察组(26例,常规护理干预+康复护理干预)。比较两组患者的护理效果。结果观察组患者的训练依从率显著高于对照组(P<0.05)。护理后,两组患者的FVC、FEV1、MVV水平、SCIM-Ⅲ评分、生活质量评分明显升高,且观察组显著高于对照组(P<0.05)。结论康复护理干预应用于颈脊髓损伤伴有呼吸功能障碍患者中可有效改善患者依从性和肺功能指标,促进患者呼吸功能和脊髓功能的恢复,提高患者生活质量水平,值得临床推广应用。     

Spinal cord seizures in transverse myelopathy: report of two cases

Paroxysmal sensorimotor phenomena of spinal cord origin are well documented in the literature dealing with multiple sclerosis, but have seldom been identified in other conditions. These seizures are characterized by tonic spasm in the extremities, often accompanied by painful dysesthesias, and are fleeting, usually lasting no more than two minutes. Although they may occur spontaneously, they are commonly precipitated by tactile stimulation or movement of the extremity. These episodes must be clinically differentiated from spasticity as they have been shown to be responsive to anticonvulsants such as carbamazepine (Tegretol). We present two patients admitted to our rehabilitation facility with a diagnosis of idiopathic transverse myelopathy. Clinical and diagnostic evaluation revealed no evidence of multiple sclerosis and follow-up studies for two and one-half years in case 1 and one year in case 2 continued to support the admitting diagnoses. Each patient developed focal sensorimotor phenomena relatively early in the course of the disease which interfered with rehabilitation. Effective treatment was obtained with administration of carbamazepine. Subsequently, both patients developed signs and symptoms of multiple sclerosis. The complication of spinal cord seizures may become a limiting factor in the rehabilitation of patients with idiopathic transverse myelopathy unless the disorder is recognized and appropriate anticonvulsant therapy initiated. It may also be the first indicator that multiple sclerosis rather than "idiopathic" transverse myelopathy is present.     

Neoplastic versus traumatic spinal cord injury: an outcome comparison after inpatient rehabilitation.

OBJECTIVE: To compare outcomes of patients with neoplastic spinal cord compression (SCC) to outcomes of patients with traumatic spinal cord injury (SCI) after inpatient rehabilitation. DESIGN: A comparison between patients with a diagnosis of neoplastic SCC admitted to an SCI rehabilitation unit and patients with a diagnosis of traumatic SCI admitted to the regional Model Spinal Cord Injury Centers over a 5-year period, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. SETTING: Tertiary university medical centers. PATIENTS: Twenty-nine patients with neoplastic SCC and 29 patients with SCI of traumatic etiology who met standard rehabilitation admission criteria. MAIN OUTCOME MEASURES: Acute and rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, and discharge rates to home. RESULTS: Patients with neoplastic SCC had a significantly (p < .01) shorter rehabilitation LOS than those with traumatic SCI (25.17 vs 57.46 days). No statistical significance was found in acute care LOS. Motor FIM scores on admission were higher in the neoplastic group, but discharge FIM scores and FIM change were significantly lower. Both groups had similar FIM efficiencies and community discharges. CONCLUSIONS: Patients with neoplastic SCC can achieve rates of functional gain comparable to those of their counterparts with traumatic SCI. While patients with traumatic SCI achieve greater functional improvement, patients with neoplastic SCC have a shorter rehabilitation LOS and can achieve comparable success with discharge to the community.     

Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation.

OBJECTIVE: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. DESIGN: Multicentre longitudinal study. SUBJECTS: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. METHODS: Assessments at the start of active rehabilitation (n=212), 3 months later (n=143), at discharge (n=191) and 1 year after discharge (n=143). RESULTS: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. CONCLUSION: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.     

Evaluation of selected laboratory components of a comprehensive periodic health evaluation for veterans with spinal cord injury and disorders

OBJECTIVE: To evaluate selected laboratory components of a comprehensive periodic health evaluation program for patients with spinal cord injury and disorders (SCI/D). DESIGN: A retrospective study. SETTING: A Department of Veterans Affairs spinal cord injury center. PARTICIPANTS: Community-dwelling male veterans with SCI/D (N=350). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Proportion of laboratory tests that resulted in new diagnoses (diagnostic yield) and proportion of laboratory tests that resulted in changes in management (therapeutic yield). RESULTS: Although abnormality rates for many routine laboratory tests were high (up to 31.5%), diagnostic and therapeutic yields were low (<1.5%), with the exception of glucose (therapeutic yield, 3.4%) and lipid tests (up to a 4.1% diagnostic and 15.2% therapeutic yield). CONCLUSIONS: Our data revealed that diagnostic and therapeutic yields for many laboratory components of the annual PHE program for veterans with SCI/D were low, consistent with findings in the general ambulatory population. Further data collection, particularly prospective longitudinal data, may help optimize the selection and frequency of laboratory tests performed as part of this program.     

X线平片与CT检查在脊柱损伤诊断中的应用比较

目的:研究分析X线平片与CT在脊柱损伤诊断的应用价值,在临床资料中选取最优方式进行诊断治疗。材料与方法:针对我院2010年3月-2014年3月期间收治的80例脊柱损伤患者的临床资料进行回顾性分析,针对使用X线平片与CT检查,对比分析检查结果。结果:X线平片检查发现68例患者椎体骨折,占所有患者总数的85%;CT检查发现80例研究对象均患有椎体骨折,多椎体骨折34例,椎管狭窄46例。其中胸椎损伤患者36例,腰椎损伤患者20例,颈椎损伤患者18例,胸腰椎损伤患者6例。结论:X线平片与CT检查均为检查脊柱损伤的有效方法,CT检查敏感度较高,能够有效检查脊柱损伤范围和深度,具有较高诊断价值,相对优于X线平片。     

Closed head injury in spinal cord injured patients: retrospective study of loss of consciousness and post-traumatic amnesia

Previous studies of trauma-related spinal cord injured patients suggest that 25% to 50% of these patients sustain a concomitant cranio-cerebral trauma. A loss of consciousness (LOC) of 20 minutes' duration or a post-traumatic amnesia (PTA) lasting 24 hours has been associated with deficits in concentration, attention, memory, and higher-level cognitive functions. These may present as significant factors influencing learning and adaptation during and after the formal rehabilitation process. A systematic review was performed of the medical records of 101 trauma-related spinal cord injured patients who were admitted to Northwestern Memorial Hospital and the Rehabilitation Institute of Chicago within seven days of injury. The reported incidence of LOC and PTA in spinal cord injured patients was evaluated, and these data were compared with the level and etiology of injury, and with radiographic work-up, if any, for head injury. Eighty-seven percent of all emergency room admissions and 67% of all rehabilitation admissions were assessed for LOC. Fewer than 25% of all patients in both settings were assessed for PTA. Forty-two percent of all patients reported LOC, PTA, or both occurring simultaneously with the spinal cord injury. Assessment and incidence were unrelated to level of injury but were influenced by etiology. One-third of the patients who reported LOC, PTA, or both underwent further evaluation with computed tomographic (CT) scan or radiography of the skull. Assessment of LOC is conducted more consistently in the ER than in the rehabilitation setting. Assessment of PTA is performed infrequently despite its relevance to the rehabilitation process. Head injury may frequently be associated with traumatic spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)