脊髓损伤患者流行病学调查

目的:对脊髓损伤的流行病学情况进行调查.方法:对近15年珠江医院收治的675例脊髓损伤患者进行调查,对资料较完整的286例进行统计分析.结果:脊髓损伤286例,男女比率为7.4/1,平均年龄(36.3 ± 10.12)岁,其中工人和农民189例(66.08%).常见致伤原因为高处坠落和交通事故(占35.66%和31.12%).损伤部位:颈椎损伤82例(28.67%),胸椎损伤134例(46.85%),腰椎损伤70例(24.48%).完全性损伤 175例(61.19%),不完全性损伤111例(38.81%).手术治疗211例(73.78%),行康复治疗者55例(19.23%).并发症的发生率为96.5%.死亡48例,占16.78%.结论:脊髓损伤的主要致伤原因为高处坠落和交通事故,得到系统康复治疗的比率很低,应加强安全防护教育,采取有效的防护措施,同时应加强脊髓损伤的康复.     

颅脑损伤伴颈髓损伤漏误诊25例分析

颅脑损伤合并颈椎颈脊髓损伤时容易造成漏误诊 ,我科收治此类患者 2 5例 ,漏误诊情况分析如下。1　临床资料本组占同期收治的颅脑损伤患者的 3% ;男 15例 ,女 10例 ;年龄 2 0～ 6 5岁 ,平均 32 .5岁 ;致伤原因 :车祸伤 16例 ,高处坠落伤 6例 ,其他伤 3例。颅脑损伤伴颈髓损伤情况见表 1。漏误诊时间自 4 h～ 3周不等 ,平均 10 .5 d。死亡 6例中 ,因脑挫裂伤、颅内血肿、脑疝、原发脑干损伤死亡 2例 ,其余 4例死于合并颈脊髓损伤。表 1　 2 5例颅脑损伤合并颈脊髓损伤情况颅脑损伤类型例数开颅手术 颈椎损伤节段分类型C1 齿状突骨折 C34 骨…     

儿童脊髓损伤致伤原因变化特点

目的 探讨儿童脊髓损伤致伤原因变化特点与预防策略。方法 对2015年1月1日至2019年12月31日本院收治的14岁以下脊髓损伤患儿进行致伤原因和人口学特点的回顾性分析。结果 脊髓损伤患儿共221例,其中男童62例,女童159例;在1~13岁各年龄段均有分布,中位数6岁;4~7岁患儿最多(55.7%),以女童为主(83.7%)。儿童脊髓损伤的前5位致伤原因分别是体育运动损伤78例(35.3%)、非外伤性损伤56例(25.3%)、其他外伤48例(21.7%)、交通事故24例(10.9%)和高处坠落12例(5.4%)。在体育运动损伤病例中,下腰动作导致的脊髓损伤75例(96.2%),主要发生在5~7岁(80.0%),均为无骨折脱位型胸脊髓损伤,其中完全性脊髓损伤53例(70.7%)。结论 近年来儿童因练习舞蹈下腰动作导致的脊髓损伤增多,应重视下腰训练前的专业评估和风险教育,积极采取防范措施。     

脊柱脊髓损伤62例的急诊护理

我们对2007-01—2009—01急诊收治的脊柱脊髓损伤患者进行了系统的急诊护理效果满意,现报告如下。 1临床资料 1．1一般资料 本组男49例,女13例;年龄18～56（平均36．2）岁。伤后至入我院时间最短为10min,最长为8h。致伤原因：其中交通事故伤48例,塌方压伤10例,高处坠落伤4例。损伤部位：颈椎损伤19例,胸腰段28例,腰椎损伤15例。合并躯体其他部位损伤36例：颅脑损伤6例,血气胸12例,腹部脏器伤11例,四肢和骨盆骨折7例。     

45例烧伤复合伤的治疗分析

烧伤复合伤病情复杂、严重、变化快 ,诊治也较为困难。我院近 15年共收治 4 5名烧伤复合伤患者 ,分析如下。1　临床资料1.1　病例 :4 5例患者中男 36例 ,女 9例 ;年龄 3～ 6 6岁 ,平均 33.4岁 ;致伤原因 :爆炸伤 2 5例 ,交通事故 7例 ,雷击伤2例 ,烧伤后高处坠落 4例 ,其他 7例 ;烧伤面积 1%～ 6 7% ,平均面积 11.5 % ;烧伤深度为 ～ 度 ,平均烧伤面积4 % ;受伤后到急诊室时间 1h～ 4 d,多数在 8h以内。复合伤部位见表 1。合并症及并发症 :伤后合并休克 7例 ,吸入性损伤 5例 ,中毒 8例 ;后期发生败血症1例 ,白内障 3例 ,截肢 5例 ,眼球摘…     

综合康复治疗儿童急性外伤性脊髓损伤1例报告

外伤性脊髓损伤（spinal cord injury,SCI）的发病率在我国有逐年增加的趋势。国外脊髓损伤的主要原因为车祸、运动损伤，而国内以高处坠落，砸伤和交通事故为主，运动损伤只占2%，我们收治了1例典型运动损伤所致脊，髓损伤患儿，其治疗前后临床和电生理表现明显改善。现报道如下。[第一段]     

应用Orem自理理论对17例脊髓损伤高位截瘫患者的护理体会

2002年1月～2004年12月,江苏省仪征市人民医院共收治脊髓损伤(SCI)高位截瘫患者17例,损伤的原因多为突发事件,复合伤多,病情复杂,护理问题繁多。作者运用Orem的自理理论对其实施护理,取得较好效果,现将护理体会介绍如下。1临床资料本组17例患者中男15例,女2例,年龄21～66岁,平均46岁。车祸7例,高处坠落4例,砸伤4例,骑自行车跌伤2例。17例中,16例为有骨折型颈脊髓损伤,1例为无骨折型颈脊髓损伤。除2例为单纯性颈脊髓损伤,其它15例均为复合伤。住院天数3～115d,平均25.8d。经治疗好转出院15例,2例因并发应激性溃疡、肺部感染而死亡。2对患者…     

21例颈椎骨折伴截瘫患者康复期的护理

<正>脊髓损伤(SCI)是指由于各种原因引起的脊髓结构、功能的损害,造成损伤水平以下运动、感觉、自主神经功能障碍。国外SCI的主要原因是车祸、运动损伤等,我国则为高处坠落、砸伤、交通事故等~([1])。颈椎损伤合并截瘫是临床脊柱外科常见多发病,约有70%合并脊髓损伤~([2])。患者通过手术治疗病情平稳后转入康复科,进行康复治疗。我康复科于2013年1月至10月共收治颈椎损伤患者21例,通过系统的     

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...     

脊髓震荡损伤9例分析

目的：探讨脊髓震荡在脊髓损伤中的发病率、受伤原因及诊断方法。方法：对2001—11／2007—08间收治9例脊髓震荡患者的受伤原因、临床表现、预后回顾性分析。结果：本组脊髓震荡发病率为1．25％，神经功能均恢复，时间20h～42d。结论：脊髓震荡发病率低，伤后为不完全性脊髓损伤，致伤暴力小且脊柱受力面积广。脊髓功能可完全恢复，最长时间6周。     

北京市五所三级医院提供和利用康复服务的影响因素研究

目的 明确北京市卫生事业机构提供和利用康复服务的影响因素.方法选取5所分布于不同区域、不同级别的三级医院进行调查,了解康复科和相关科室康复诊疗的现状和影响因素,以及康复医学科在医院的发展情况和制约其发展的影响因素.结果 5所医院康复科均未达到卫生部“综合医院康复科管理规范”的要求;影响三级医院提供康复服务的因素主要有：康复科与其他科室合作形式尚未理顺、北京市卫生系统和医院领导以及临床科室人员不了解康复早期介入的重要性、患者及其家属不了解康复对于防治残疾的特殊疗效、康复诊疗费用的报销受限制等.结论上述因素限制了我市医院康复医疗的发展,应制定相关政策予以解决.     

Sleep apnea syndrome in chronic spinal cord injury: associated factors and treatment

OBJECTIVE: To determine the prevalence of sleep apnea in a sample of persons with chronic spinal cord injury (SCI) of varying injury levels and degrees of impairment. DESIGN: Cross-sectional study. SETTING: Inpatient SCI rehabilitation unit. PARTICIPANTS: Twenty men with SCI (motor complete and incomplete; American Spinal Injury Association classes A-D) of at least 1 year's duration, randomly selected from patients with SCI undergoing elective hospitalization. MAIN OUTCOME MEASURES: Apnea index, determined by sleep study (including chest wall movement, airflow, oxygen saturation), and daytime sleepiness, determined by Epworth sleepiness score. RESULTS: Eight subjects (40%) had sleep apnea, manifested by elevated apnea index (mean +/- SD, 17.1 +/- 6.9) and excessive daytime sleepiness. Sleep apnea was commonly diagnosed in motor-incomplete injuries. A trend (p = .07) existed toward a greater prevalence of sleep apnea with tetraplegia. Age and body mass index were not associated with sleep apnea. CONCLUSION: The prevalence of sleep apnea in men with chronic SCI admitted for nonrespiratory elective hospitalization is high relative to the general population.     

Medical complications during acute rehabilitation following spinal cord injury--current experience of the Model Systems

OBJECTIVES: To examine the frequency of common secondary medical complications during acute rehabilitation in persons with new spinal cord injury (SCI). DESIGN: Survey and analysis of data in the National SCI Statistical Center (NSCISC) database. SETTING: Eighteen Model System SCI Centers located in urban, public medical centers around the United States. SUBJECTS: A total of 1,649 persons with new SCI entered into the NSCISC database between 1996 and mid-1998. RESULTS: Since 1992, the number of days from injury to admission to rehabilitation has steadily decreased, resulting in the increased potential to develop common secondary medical complications during rehabilitation hospitalization. Pressure ulcers occur with high frequency and were found to have developed in 23.7% of patients during rehabilitation. In addition, autonomic dysreflexia and atelectasis/pneumonia also occur with relative frequency during rehabilitation. Conversely, deep vein thrombosis and pulmonary embolism have decreased, most likely because of greater awareness of their potential to develop, as well as improved methods of prophylaxis. Cardiopulmonary arrest and gastrointestinal hemorrhage occur with relatively small frequency. The frequency of renal complications is difficult to gauge because of the decreasing number of patients who have any renal testing performed during rehabilitation hospitalization. CONCLUSION: The continued declining lengths of acute care hospitalization after SCI have resulted in the occurrence in the rehabilitation setting of medical complications that were previously seen in acute care. Greater awareness and attention to these conditions are necessary to reduce their occurrence, so that obstacles to recovery and functional improvement after SCI are minimized.     

An evaluation of neuropsychological rehabilitation for patients with high spinal cord injuries and brain damage

This article describes a program of neuropsychological rehabilitation for high cervical SCI patients with psycho-organic syndrome. Traumatic injury to the cervical spine is frequently accompanied by organic damage to the brain, either caused by the same accident that injured the spine or resulting from secondary causes. The result of concomitant brain damage in cervical SCI patients is psycho-organic syndrome, which consists of both cognitive (higher level language functioning, disturbances in memory, language, attention, and thinking) and personality components (mood and behavioral disorders). Existing rehabilitation programs designed either for tetraplegic patients with no neuropsychological impairment, or for brain-damaged patients without tetraplegia, are not suitable for the problems faced by these patients. Accordingly, the authors have developed a Program of Neuropsychological Rehabilitation as a module added to comprehensive rehabilitation for SCI patients. This program was tested in a natural clinical experiment involving 35 SCI patients with tetraplegia and concomitant brain damage undergoing rehabilitation at the Cracow Rehabilitation Center and the Marian Weiss Rehabilitation Center in Konstancin, Poland. The results of the experiment demonstrate that the neuropsychological rehabilitation program is effective in reducing the symptoms of psycho-organic syndrome. The authors discuss the theoretical and clinical implications of the results for the rehabilitation of patients with cervical spine injuries and concomitant brain damage.     

影响脊髓损伤患者出院时日常生活活动能力的相关因素分析

目的 探讨影响脊髓损伤(SCI)患者出院时日常生活活动(ADL)能力的相关因素.方法 对105例SCI患者进行分析,入选时收集每位患者病史,记录一般情况如性别、年龄、病因、损伤水平、损伤分级、受伤(发病)时间、手术时间、入院和出院时间等,并记录出院和入院时的改良Barthel指数(MBI)评分、美国脊髓损伤协会(ASIA)SCI积分,对影响患者出院时ADL能力的因素进行线性回归分析.结果 出院时,SCI患者ASIA运动评分、ASIA针刺觉评分、ASIA轻触觉评分和MBI评分均有改善,与入院时比较,差异有统计学意义(P＜0.01);多因素分析显示,SCI分级、入院时ASIA运动评分、入院时ASIA针刺觉评分等3个因素与出院时MBI评分密切相关,康复介入时间、康复疗程、入院时ASIA运动评分等3个因素与出入院MBI差值密切相关.结论 通过康复训练,各年龄阶段、不同损伤平面、不同损伤程度的SCI患者的ADL能力都可得到改善.入院时运动能力较好、康复疗程足够长、康复介入时间早的患者改善幅度也相对较大.     

影响脊髓损伤患者出院时日常生活活动能力的相关因素分析

目的 探讨影响脊髓损伤(SCI)患者出院时日常生活活动(ADL)能力的相关因素.方法 对105例SCI患者进行分析,入选时收集每位患者病史,记录一般情况如性别、年龄、病因、损伤水平、损伤分级、受伤(发病)时间、手术时间、入院和出院时间等,并记录出院和入院时的改良Barthel指数(MBI)评分、美国脊髓损伤协会(ASIA)SCI积分,对影响患者出院时ADL能力的因素进行线性回归分析.结果 出院时,SCI患者ASIA运动评分、ASIA针刺觉评分、ASIA轻触觉评分和MBI评分均有改善,与入院时比较,差异有统计学意义(P＜0.01);多因素分析显示,SCI分级、入院时ASIA运动评分、入院时ASIA针刺觉评分等3个因素与出院时MBI评分密切相关,康复介入时间、康复疗程、入院时ASIA运动评分等3个因素与出入院MBI差值密切相关.结论 通过康复训练,各年龄阶段、不同损伤平面、不同损伤程度的SCI患者的ADL能力都可得到改善.入院时运动能力较好、康复疗程足够长、康复介入时间早的患者改善幅度也相对较大.     

Nontraumatic spinal cord injury rehabilitation: pressure ulcer patterns, prediction, and impact

OBJECTIVE: To investigate the characteristics, predictors, and consequences of pressure ulcers in patients with nontraumatic spinal cord injury (SCI). DESIGN: Retrospective, 3-year, case series. SETTING: Tertiary medical unit specializing in SCI rehabilitation. PARTICIPANTS: Consecutive sample of 134 adult inpatient referrals with nontraumatic SCI. Patients requiring initial rehabilitation or readmission were included. INTERVENTION: Chart review. MAIN OUTCOME MEASURES: Primary outcome measures were presence of pressure ulcers on admission to rehabilitation, incidence of new pressure ulcers developing during hospitalization, and any complications attributable to pressure ulcers during inpatient rehabilitation. Secondary objectives were to examine the predictability of risk factors for pressure ulcers, to assess the usefulness of a model previously developed for predicting pressure ulcers in patients with chronic SCI, and to estimate the effect of pressure ulcers on rehabilitation of nontraumatic SCI. RESULTS: Prevalence of pressure ulcers among admissions was 31.3% (n=42). Only 2.2% (n=3) of patients developed a new pressure ulcer after admission. The length of stay (LOS) of patients admitted with a pressure ulcer was significantly longer than that of those without a pressure ulcer (geometric mean, 62.3 d for pressure ulcer vs 28.2 d for no pressure ulcer, P=.0001). Many previously identified risk factors for pressure ulcers in SCI patients did not apply to our nontraumatic SCI patients. It is estimated that the inpatient LOS for those patients with a significant pressure ulcer was increased by 42 days. CONCLUSIONS: Pressure ulcers are a common complication for people with nontraumatic SCI who are admitted for rehabilitation, and they have a significant impact on LOS.     

Predicting "charge outliers" after spinal cord injury: a multicenter analysis of demographics, injury characteristics, outcomes, and rehabilitation charges

OBJECTIVE: To describe the distribution of charges, to distinguish between "charge outliers" and nonoutliers, and to identify a model that uses demographics and injury characteristics to predict charge outlier status in individuals with spinal cord injury (SCI). DESIGN: Retrospective data analysis of patients admitted to 24 acute inpatient rehabilitation national Spinal Cord Injury Model Systems centers. Statistical analysis, including proportions, means, and standard deviations (SDs), were compiled for the following variables: demographic and injury information, rehabilitation charges, medical complications, associated injuries, and surgical procedures. SETTING: Tertiary, university medical centers participating in the National Institute on Disability and Rehabilitation Research's SCI Model Systems project. PARTICIPANTS: A total of 13,392 patients who were admitted to 24 acute, intensive, interdisciplinary rehabilitation settings after traumatic SCI between November 1972 and August 1996. MAIN OUTCOME MEASURES: Statistical data analysis was used to determine significance between charge outliers and nonoutliers on the basis of demographic, injury characteristics, and clinical factors. Outliers, under the current diagnostic-related group system, are defined as cases in which lengths of stay exceed the mean by the lesser of 20 days or 1.94 SDs. RESULTS: Statistically significant differences were found between SCI charge outliers and nonoutliers based on ethnicity, education, employment, level of injury, American Spinal Injury Association impairment classification, and sponsor of hospitalization. On average, outliers were 4 years older than nonoutliers, and tended to have more associated injuries, pressure ulcers, surgical procedures, and medical complications. A forward-conditional stepwise multiple logistic regression analysis was used to confirm univariate analysis and to predict the presence or absence of outliers based on the predictor variables. A model for the prediction of SCI charge outlier status was defined. CONCLUSIONS: SCI charge outliers are most likely to be retired, insured, have high cervical level injuries, and be educated beyond high school. Improved treatment efficiency serves as a means of cost reduction and is a reason to identify outlier characteristics.     

Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis

OBJECTIVE: To analyze the incidence, risk factors, and trends of long-term secondary medical complications in individuals with traumatic spinal cord injury. DESIGN: Data were reviewed from the National SCI Statistical Center on annual evaluations performed at 1, 2, 5, 10, 15, and 20 years after injury on patients injured between 1973 and 1998. SETTING: Multicenter Regional SCI Model Systems. MAIN OUTCOME MEASURES: Secondary medical complications at annual follow-up years, including pneumonia/atelectasis, autonomic dysreflexia, deep venous thrombosis, pulmonary embolism, pressure ulcers, fractures, and renal calculi. RESULTS: Pressure ulcers were the most frequent secondary medical complications in all years, and individuals at significant (p < .05) risk included those with complete injuries (years 1, 2, 5, 10), younger age (year 2), concomitant pneumonia/atelectasis (year 1, 2, 5), and violent injury (years 1, 2, 5, 10). The incidence of pneumonia/atelectasis was 3.4% between rehabilitation discharge and year-1 follow-up with those most significantly at risk being older than 60 years (years 1, 2, 5, 10) and tetraplegia-complete (years 1, 2). One-year incidence of deep venous thrombosis was 2.1% with a significant decline seen at year 2 (1.2%), and individuals most significantly (p < .001) at risk were those with complete injuries (year 1). The incidence of calculi (kidney and/or ureter) was 1.5% at 1-year follow-up and 1.9% at 5 years and was more frequent in patients with complete tetraplegia. Intermittent catheterization was the most common method of bladder management among patients with paraplegia but became less common at later postinjury visits. CONCLUSIONS: Pressure ulcers, autonomic dysreflexia, and pneumonia/atelectasis were the most common long-term secondary medical complications found at annual follow-ups. Risk factors included complete injury, tetraplegia, older age, concomitant illness, and violent injury.     

Forecasting of spinal cord injury annual case numbers in Australia

OBJECTIVES: To forecast annual numbers of cases of spinal cord injury (SCI) and to assess the effect on case mix. DESIGN: Cohort of incident cases from 1986 to 1997, with forecasting to 2021. SETTING: Australian cases registered by treatment centers for the acute care and rehabilitation of SCI patients. PARTICIPANTS: A total of 2959 SCI patients, aged 15 years and over, identified through the Australian Spinal Cord Register. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Incidence and case mix. RESULTS: If the recent trends in SCI continue (ie, a 6.21% per annum rate increase in elderly men and a 2.8% per annum rate decrease in young men), the annual number of cases will increase from 253 in 1997 to 464 in 2021. In addition, the case mix would change substantially and the number and proportion of elderly persons with SCI would increase from 32 cases per annum in 1997 (13% of cases) to 233 per annum in 2021 (47% of cases). In addition, there would be a 143% increase in the number of cases of incomplete tetraplegia, from 88 cases per annum in 1997 to 214 cases per annum in 2021. Substantial increases would occur even if the age-specific rates of SCI were stable over the period. CONCLUSIONS: Population growth, and aging, plus increasing rates of SCI in the elderly will have profound effects on the expected number of SCI patients and their case mix. Treatment centers in Australia will need to plan for these changes. At the same time, there should be increased efforts to prevent SCI in order to ameliorate the problem.