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     

Biostep运动训练系统在腰髓完全性损伤患者康复训练中的应用

目的:研究在常规康复治疗的基础上,应用Biostep运动康复训练系统对腰髓完全性损伤患者进行运动训练的意义。方法:46例腰髓完全性损伤患者,随机分为Biostep训练组(治疗组)和常规康复训练组(对照组),每组各23例。两组患者均接受常规综合康复治疗,治疗组在此基础上,增加Biostep运动训练治疗。在治疗前和治疗2个月后对两组患者进行ASIA下肢运动评分、脊髓损伤步行指数Ⅱ(WISCIⅡ)、10m步行测试(10MWT)及功能独立性评定(FIM)。结果:两组治疗前后组内比较,治疗后ASIA运动评分、WISCIⅡ、10MWT和FIM评分均有明显提高,差异有显著性意义(P<0.05)。治疗组在ASIA下肢运动评分、WISCIⅡ和10MWT方面改善均优于对照组,差异有显著性意义(P<0.05)。结论:常规康复治疗辅以Biostep康复训练系统进行训练,对提高腰髓完全性损伤患者步行功能有重要意义。     

后路广泛减压侧块螺钉固定治疗无骨折脱位长节段颈髓损伤

【目的】探讨无骨折脱位型长节段颈髓损伤的损伤机制以及后路广泛减压侧块螺钉内固定手术的治疗效果。【方法】对31例无骨折脱位型长节段颈髓损伤的患者,其中先天性颈椎管狭窄和继发性颈椎管狭窄的颈脊髓损伤共25例（80．65％）;伴后纵韧带钙化3例（9．68％）;伴多节段颈椎间盘突出2例（6．45％）,采用后路广泛减压侧块螺钉内固定手术治疗,观察脊髓功’能的变化及评价其临床疗效。【结果】31例术后随访3～17个月,平均9个月,术静ASIA评分平均为96．63±6．4分,术后3周ASIA评分平均为158．53±12．4分,术后3个月ASIA评分平均为18i．68±12．6分,术前和术后两者有统计学显著性差异（P〈0．05）,术后两者无统计学显著性差异（P〉0．05）。除2例术后脊髓功能无改善外,其余患者均有不同程度恢复。【结论】颈椎椎管狭窄是无骨折脱位型颈髓损伤的重要原因;作用因素有惯性作用和直接外力;后路广泛减压侧块螺钉内固定手术能获得较理想的脊髓功能恢复效果。     

经后路椎弓根螺钉内固定治疗不稳定上胸椎骨折临床观察

目的 观察经后路椎弓根螺钉内固定技术治疗不稳定上胸椎骨折的临床疗效。方法 回顾性分析2010年3月至2013年4月收治的21例不稳定上胸椎骨折患者临床资料。骨折节段为T3～T8,均为高能量损伤。所有患者实施经后路切开复位、脊髓减压、椎弓根螺钉内固定、后外侧植骨融合术。术后常规处理,并接受早期康复治疗。对手术前后患者的①基本情况;②影像学评价（包括椎弓根螺钉位置、椎体压缩率、椎体后凸角度）;③脊髓神经功能分级（ASIA ）;④日常生活活动能力（ADL ）评分进行评价。结果 21例患者全部顺利完成手术,无术后出现并发症。20例患者获得有效随访,随访时间为12～49个月,平均随访时间（28．78±6．25）个月。术后48 h及随访时的椎体压缩率、椎体后凸角均较术前降低（ P ＜0．01）,但随访时的椎体压缩率、椎体后凸角则均较术后48 h有所增加（ P ＜0．05）。术后48 h脊髓损伤ASIA分级均无明显变化。随访时,50．0％病例的脊髓损伤ASIA分级得到恢复,日常生活活动能力（ADL ）评分在随访时得到显著提高（ P ＜0．05） ,平均提高（22．11±9．64）分。结论 经后路椎弓根螺钉内固定技术是治疗不稳定上胸椎骨折的有效方法,配合术后早期康复治疗是患者脊髓功能恢复的关键。     

Early rehabilitation effect for traumatic spinal cord injury

OBJECTIVE: To determine the natural course of traumatic spinal cord injury (SCI) and the effect of early rehabilitation on it. DESIGN: A retrospective, multicenter study. SETTING: Sixteen Rosai hospitals and 1 medical school. PARTICIPANTS: One hundred twenty-three SCI patients (104 men, 19 women; mean age, 48.8 +/- 17.7yr) enrolled. INTERVENTIONS: Dividing the subjects into an early rehabilitation group and a delayed group; differences were ensured by international classification of SCI. MAIN OUTCOME MEASURES: Using the American Spinal Injury Association (ASIA) classifications, the motor recovery rate (MRR) was defined as (ASIA motor score at discharge - ASIA motor score at admission)/(100 - ASIA motor score at admission). The regression lines for FIM instrument score and ASIA motor score were determined for 6 subgroups (early or delayed tetraplegia, central cord injury, paraplegia) by the MRR staging. The regression lines for physical or cognitive FIM score and ASIA motor score were also determined for 6 subgroups. RESULTS: Three stages were obtained: acute stage: 2 weeks postinjury; recovery stage: 2 weeks to 6 months postinjury; and chronic stage: more than 6 months postinjury. Regression lines showed that rehabilitation improved physical functional independence for ASIA motor score, especially in the early rehabilitation subgroups. There was no correlation between cognitive FIM score and ASIA motor score in 6 subgroups. CONCLUSION: Early SCI rehabilitation contributes to good physical activities of daily living for motor function.     

汶川地震脊髓损伤患者日常生活活动能力预后的相关因素分析

目的：探讨汶川地震脊髓损伤患者治疗前后影响日常生活活动（ADL）能力的相关因素。方法：选择可能对脊髓损伤患者临床预后有影响的因素,以入院康复治疗2个月后改良Barthel指数（MBI）为预后指标,进行回顾性和多因素分析。入选病例为35例地震致脊髓损伤患者。结果：经康复治疗2个月后,患者的MBI从治疗前的15.17提高到58.71。治疗后的ADL能力与年龄、康复介入时机、治疗前ADL评分不相关;与ASIA损伤等级、神经平面呈正相关;与受压时间、并发症数呈负相关。结论： ASIA损伤等级、神经平面、受压时间、并发症数都是影响地震致脊髓损伤患者ADL能力预后的主要因素。     

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.     

非创伤性脊髓损伤的临床特点

目的探讨非创伤性脊髓损伤患者的人口学特征、病因学分布以及神经功能预后。方法对44 例非创伤性因素造成的脊髓损伤患者的临床资料进行回顾性分析。结果患者均获得3 个月以上随访,平均随访时间13.3 个月(3~23 个月)。其中男性27 例(61.3%),女性17 例(38.7%);平均年龄39.85 岁(3.5~78 岁)。病因包括脊髓炎16 例(36%),脊柱肿瘤8 例(18.1%),椎管内肿瘤7例(15.9%),脊髓血管畸形6 例(13.6%),非创伤性椎间盘突出3 例(6.8%,包括颈椎间盘突出致四肢瘫1 例,腰椎间盘突出致马尾综合征2 例),非脊柱手术造成的医源性脊髓缺血2 例(4.5%),肝性脊髓病2 例(4.5%)。入院时神经损伤情况：颈段脊髓损伤9 例(20.4%),胸段损伤30 例(68.1%),圆锥综合征2 例(4.5%),马尾综合征3 例(6.8%)。AISA 残损分级：A级14 例(31.8%),B级6 例(13.6%),C级13 例(29.5%),D级11 例(25%)。最终随访时,34%患者出现至少1 个等级的神经功能恢复。结论非创伤性脊髓损伤是造成脊髓损伤的重要原因。因具有特殊的病因学特点,此组病例在人口学特征以及临床特点上与创伤性脊髓损伤患者有较大区别。     

早期高压氧治疗对急性创伤性脊髓损伤患者疗效的影响

【目的】探讨早期高压氧（HBO）治疗对急性创伤性脊髓损伤（SCI）患者疗效的影响。【方法】将86例急性脊髓损伤患者随机分为早期HBO组（A组）28例、晚期HBO组（B组）32例及对照组（C组）26例。C组采取常规处理（包括脱水剂、皮质激素、神经营养药物、胃黏膜保护药物、康复训练、针灸以及对症支持治疗等）,A组患者在此基础上于SCI发生12h以内辅以HBO治疗,B组患者在此基础上于SCI发生3d以后辅以HB0治疗,于治疗前及治疗3个月后分别采用美国脊髓损伤协会（ASIA）评分、改良Barthel指数（MBI）及功能独立性评定量表（FIM）对患者进行测评。【结果】三组患者ASIA感觉、运动功能评分及MBI、FIM分值均较治疗前显著改善（P〈0．01）,组间治疗后ASIA感觉功能评分比较有显著差异（P〈0．01）,治疗后ASIA运动功能评分比较有显著差异（P〈0．05）。治疗后各组间MBI及FIM分值比较有显著性差异（P〈0．01）。【结论】HBO能显著改善急性SCI患者脊髓功能、日常生活活动能力及独立能力,且越早开始治疗效果越好。     

Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury

OBJECTIVE: To compare neurologic, medical, and functional outcomes of patients with acute spinal cord injury (SCI) undergoing early (<24 h and 24-72 h) and late (>72 h) surgical spine intervention versus those treated nonsurgically. DESIGN: Retrospective case series comparing outcomes by surgical and nonsurgical groups during acute care, rehabilitation, and at 1-year follow-up. SETTING: Multicenter National Spinal Cord Injury Database. PARTICIPANTS: Consecutive patients with acute, nonpenetrating, traumatic SCI from 1995 to 2000, admitted in the first 24 hours after injury. Surgical spinal intervention was likely secondary to nature of injury and the need for spinal stabilization. Interventions Not applicable. MAIN OUTCOME MEASURES: Changes in neurologic outcomes (motor and sensory levels, motor index score, American Spinal Injury Association [ASIA] Impairment Scale [AIS]), medical complications (pneumonia and atelectasis, deep vein thrombosis and pulmonary embolism, pressure ulcers, autonomic dysreflexia, rehospitalization), and functional outcomes (acute and rehabilitation length of stay [LOS], hospital charges, FIM instrument score, FIM motor efficiency scores). RESULTS: Subjects in the early surgery group were more likely ( P <.05) to be women, have paraplegia, and have SCI caused by motor vehicle collisions. The nonsurgical group was more likely ( P <.05) to have an older mean age and more incomplete injuries. ASIA motor index improvements (from admission to 1-y follow-up) were more likely ( P <.05) in the nonsurgical groups, as compared with the surgical groups. Those with late surgery had significantly ( P <.05) increased acute care and total LOS and hospital charges along with higher incidence of pneumonia and atelectasis. No differences between groups were found for changes in neurologic levels, AIS grade, or FIM motor efficiency. CONCLUSIONS: ASIA motor index improvements were noted in the nonsurgery group, though likely related to increased incompleteness of injuries within this group. Early versus late spinal surgery was associated with shorter LOS and reduced pulmonary complications, however, no differences in neurologic or functional improvements were noted between early or late surgical groups.     

神经肌肉电刺激辅助治疗脊髓损伤神经源性膀胱的临床探析

目的：探讨神经肌肉电刺激辅助治疗脊髓损伤神经源性膀胱（NB）的临床疗效。方法将72例脊髓损伤NB患者随机分为电刺激组和常规组各36例。常规组仅接受康复治疗结合膀胱训练等常规治疗,观察组在常规组治疗基础上辅助接受神经肌肉电刺激治疗。比较两组治疗后的总有效率、24 h排尿次数、每次排尿量、残余尿量以及神经功能评分（ASIA评分）。结果治疗后观察组的总有效率、24 h 排尿次数、每次排尿量、残余尿量方面均优于常规组[分别为97.2％ vs.55.6％,（5.1±1.2）次vs （8.3±2.2）次,（189.9±11.4）ml vs （145.3±10.8）ml,（90.2±2.4） ml vs （110.1±3.3）ml,均为P＜0.05]。两组的ASIA评分比较差异无统计学意义（P＞0.05）。两组均无发生明显不良反应。结论神经肌肉电刺激辅助治疗能明显改善脊髓损伤NB患者临床症状,有利于患者康复,是一种治疗NB的好的辅助疗法。     

基于3D高分辨肛门直肠测压研究针刺对脊髓损伤神经源性肠道的疗效

目的:利用3D高分辨肛门直肠测压(3DHR-ARM)观察针刺联合常规康复治疗对脊髓损伤后神经源性肠道(NBD)的疗效。方法:选取外伤致脊髓损伤术后神经源性肠道患者40例,随机分为对照组与研究组各20例,对照组予常规康复治疗,进行肠道功能训练,研究组在此基础上再配合针刺治疗,应用3D HR-ARM、美国脊柱损伤协会(ASIA)评分、神经源性肠道功能障碍(NBD)评分、Barthel指数(BI)对患者进行评定。结果:治疗后,2组肛门括约肌收缩压、直肠压力、直肠肛管压力差、Barthel指数(BI)评分、美国脊柱损伤协会(ASIA)评分较治疗前均明显提高(均P<0.05),便意阈值、神经源性肠道(NBD)评分较治疗前均明显下降(均P<0.05),静息压、高压带长度治疗前后差异无统计学意义,其中,研究组肛门括约肌收缩压、直肠压力、直肠肛管压力差、便意阈值较对照组差异均有统计学意义(均P<0.05)。Pearson相关性分析结果显示:肛门括约肌收缩压、BI评分与ASIA评分成正相关(P<0.05),便意阈值、NBD评分与ASIA评分成负相关(P<0.05)。结论:针刺联合常规康复治疗能更有效地改善脊髓损伤后神经源性肠道功能,3D高分辨肛门直肠测压结果与量表评定具相关性,有望成为神经源性肠道疗效的客观评价指标。     

早期康复对脊髓损伤患者步行功能恢复的临床观察

目的探讨早期康复对脊髓损伤患者步行能力的影响及运动和感觉功能与步行能力之间的相关性。方法对 47例脊髓损伤患者给予综合康复治疗 ,在入院时和治疗过程中根据美国脊髓损伤学会 (ASIA) 1992年的标准评定患者的运动与感觉功能 ,采用Hoffer步行能力分级评定步行能力。结果伤后 12个月时患者的运动功能和感觉功能比入院时显著增加 (P <0 0 5 ) ,入院时的运动功能与患者最终获得的步行能力相关 (P <0 0 5 )。结论早期康复能改善脊髓损伤患者的运动功能和感觉功能 ,入院时的运动功能与患者最终获得的步行能力相关     

中西医结合治疗外伤性脊髓损伤并截瘫的疗效及护理

目的 探讨中西医结合治疗外伤性脊髓损伤并截瘫的疗效及护理措施.方法 对98例外伤性脊髓损伤并截瘫的患者进行椎管减压内固定术及术后使用降纤酶、中药治疗,加强体位护理、情志护理、并发症的预防及护理、系统性康复训练等干预措施,治疗前后采用Barthel指数法对患者的日常生活活动（ADL）能力进行评定.结果 治疗后98例患者的Barthel指数评分均明显高于治疗前（P＜0.05）,无并发症的发生.结论 对外伤性脊髓损伤并截瘫患者采用椎管减压内固定术及术后使用降纤酶、中药治疗的同时,给予及时、正确的护理干预措施,可提高治愈率,减少并发症的发生,提高生活质量.     

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。     

脊髓损伤合并截瘫病人膀胱功能障碍的康复护理效果观察

[目的]观察脊髓损伤合并截瘫病人膀胱功能障碍的康复护理效果。[方法]将142例脊髓损伤合并截瘫伴膀胱功能障碍病人随机分为两组,观察组92例,对照组50例,观察组进行综合康复护理,对照组进行常规膀胱引流护理,观察并比较两组病人的膀胱功能障碍恢复情况。[结果]与对照组比较,康复组病人留置尿管时间缩短,膀胱容量增加,残余尿量减少,尿路感染率降低(P均<0.05);康复组总有效率为84.78%,对照组为18.00%,康复组优于对照组(P<0.05)。[结论]康复护理能显著提高脊髓损伤合并截瘫病人伴膀胱功能障碍的排尿功能,降低尿路感染并发症。     

完全性与不完全性颈髓损伤并发血栓栓塞症的对照研究

目的探讨完全性与不完全性颈髓损伤并发血栓栓塞症的发生率。方法在2007 年1 月~2010 年12 月收治的177 例急性颈髓损伤患者,ASIA分级：A级52 例为观察组,B~D级125 例为对照组,均采用低分子肝素和康复治疗预防血栓栓塞症,比较两组并发血栓栓塞症的情况。结果观察组并发血栓栓塞症11 例(21.2%),对照组并发血栓栓塞症6 例(4.8%),两组比较具有显著性差异(P<0.05)。结论完全性颈髓损伤发生血栓栓塞症的危险性高于不完全性颈髓损伤。     

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.     

康复训练对脊髓损伤患者生活自理能力的影响

目的探讨脊髓损伤患者经过康复训练后生活自理能力与发病初期脊髓损伤程度之间的关系。方法回顾性分析30例脊髓损伤的患者,按照美国脊髓损伤学会脊髓损伤程度的分级(ASIA)进行分类,对他们进行相同的PT、OT、神经肌肉电刺激、针灸、按摩治疗,按照日常生活能力量表(见附表1)观察治疗前后日常生活能力的改善。对收集的资料进行相关性分析。结果相关性分析表明,ADL改善程度和ASIA级别密切相关(r=0.229),经过康复训练后,生活自理能力均有提高。而分级指数越高,生活自理能力改善的程度越明显。结论脊髓损伤患者进行ASIA分级是必要的,可以预测未来生活自理能力。而提高生活自理能力的关键是进行康复训练。     

Neoplastic vs. traumatic spinal cord injury: an inpatient rehabilitation comparison

OBJECTIVE: To compare demographics, injury characteristics, and functional outcomes of patients with neoplastic spinal cord compression with those with traumatic spinal cord injuries. DESIGN: A prospective 5-yr comparison was undertaken comparing 34 patients with neoplastic spinal cord compression with 159 patients with traumatic spinal cord injury. RESULTS: Patients with neoplastic spinal cord compression were significantly older, more often female, and unemployed than patients with traumatic spinal cord injury. Neoplastic spinal cord compression presented more often with paraplegia involving the thoracic spine, and injuries were more often incomplete compared with traumatic spinal cord injury. Patients with neoplastic spinal cord compression had a significantly shorter rehabilitation length of stay compared with those with traumatic spinal cord injury. The neoplastic group had significantly lower FIM change scores. Both groups had similar FIM efficiencies and discharge to home rates. CONCLUSIONS: Patients with neoplastic spinal cord compression have different demographic and injury characteristics but can achieve comparable rates of functional gains as their traumatic spinal cord injury counterparts. Although patients with traumatic injuries achieve greater functional improvement, patients with neoplasms have a shorter rehabilitation length of stay and comparable FIM efficiencies and home discharge rates.