椎管损伤与脊髓损伤相关性研究的现状

椎管的完整性对保护脊髓及马尾神经免受损伤起到重要的作用,而目前的研究表明椎管损伤是造成脊髓神经组织损伤及阻止神经功能恢复的主要因素.现就目前对在脊柱爆裂型骨折中椎管损伤与脊髓损伤相关性研究的现状及进展综述如下:     

高浓度庆大霉素误注椎管内致脊髓损伤截瘫一例报告

患者男，３９岁。２０００年６月２２日因腰椎间盘突出症入他院行按摩牵引治疗，症状有所缓解。１个月后分别在右L４－５、L５S１侧隐窝行封闭治疗（药物为２％利多卡因５ml、地塞米松５mg、庆大霉素１２万u）后，发现患者剑突以下感觉、运动功能完全丧失，呼吸困难，经抢救，感觉障碍平面逐渐下降，二便失禁。行MR检查，见从T８中间水平到脊髓圆锥部，脊髓内条状T２高信号（图１）。考虑：胸下段脊髓损伤。转到我院骨科治疗。查体：自腹股沟以下皮肤感觉减弱，触觉、位置觉存在，上、中腹壁反射存在，下腹壁反射、提睾反射、右膝腱反射…     

椎管内充气注药治疗脊髓损伤并截瘫50例体会

椎管内充气注药治疗脊髓损伤并截瘫５０例体会赵书安，周现，于新民，单建华作者自１９９０年５月～１９９５年６月共收治脊髓损伤及蛛网膜粘连所致的截瘫患者１００例，经椎管内充气注药治疗５０例。取得了较满意的疗效。另外５０例作为对照组，用营养神经药物治疗，两组...     

胸腰椎爆裂骨折损伤部位和椎管内占位程度与神经损伤的关系

目的探讨胸腰椎爆裂骨折骨折部位及椎管内骨块占位程度与神经损伤的关系。方法对213例胸腰椎爆裂骨折根据骨折部位及CT测出的椎管内骨折骨块占位程度与神经损伤进行分析评定。结果神经损伤组椎管骨折骨块占位程度明显高于无神经损伤组;在有神经损伤情况下,骨折部位椎管内骨块占位程度腰段大于胸腰段;神经损伤程度与椎管内骨块占位程度无显著相关。结论胸腰椎爆裂骨折椎管内骨块占位压迫是神经损伤的重要因素;神经损伤与骨折部位和椎管内骨块占位程度联合相关。     

椎管侧前方减压脊柱融合治疗胸腰椎骨折并脊髓损伤

目的：探讨胸腰椎骨折并脊髓损伤的治疗方法。方法：采用后入路半棍板切除棍管侧前方减压，Dick经棍弓根内固定，同时行后外侧值骨。结果：28例随访X线复查示骨折椎体复位率达90％，椎体前缘压缩平均恢复高度0．8cm。1例1钉折断，余固定牢固。神经恢复好转率89％(25／28)。结论：认为该手术治疗胸腰椎骨折并脊髓损伤创伤小，手术操作简便，术后恢复好。     

胸腰椎爆裂型骨折椎管狭窄与脊髓损伤的关系

胸腰椎爆裂型骨折的主要特征为椎体前高的减低和后壁骨皮质的连续性中断,骨折常常发生向后移位突入椎管导致神经损伤。据统计,胸腰椎爆裂型骨折后有３０％～９０％的患者发生包括脊髓、圆锥或马尾在内的神经损伤〔１〕。但迄今有关创伤后椎管狭窄与神经损伤的关系尚不明...     

椎管内阻滞与镇痛时应警惕脊髓栓系综合征

人在生长发育过程中，椎管的生长速度大于脊髓，因此脊髓下端相对于椎管下端逐渐升高。脊髓栓系综合征（TCS）是由于先天（如母亲妊娠早期病毒感染或严重缺乏叶酸等）或后天（如脂肪瘤、囊肿或神经损伤）原因造成脊髓下端栓系固定，不能正常上升，脊髓受牵拉，发生缺血性损伤，从而产生一系列神经功能障碍和畸形的征候群。该病多数在儿童时发现，但一部分TCS起病隐匿，发展缓慢，至成人时尚未发现，因此麻醉科医生行椎管内阻滞或镇痛前如发现TCS的典型体征及症状时应引起警惕，防止引起医源性损伤。     

脊髓髓外冲击负荷后脊髓血流与诱发电位变化的相关研究

[目的] 研究脊髓髓外冲击负荷对脊髓血流及诱发电位的影响,探讨脊髓损伤后脊髓血流与诱发电位变化的规律,以及它们之间的相关性.[方法] 选用雄性SD大鼠120只,随机分为4组,每组30只,A组为假手术组,B、C、D为实验组,在大鼠T10椎板处分别给予10、15、20 N的椎板外冲击负荷.术后0 min,1、6 h,1、6、12、24 d时间点测量冲击负荷位置的脊髓白质、灰质血流以及SEP、MEP测量,进行相关性分析.[结果] 脊髓内灰质白质的血流表现出随冲击负荷的增加而减小的趋势.A组脊髓血流及SEP、MEP无明显变化,B组脊髓血流及SEP、MEP出现一过性降低然后恢复正常,两组之间无明显差异.C、D组脊髓血流及SEP、MEP均表现为持续下降后再缓慢的回升的规律性变化,其中C组在24 d恢复正常,D组在24 d时仍然低于正常,经统计学分析脊髓血流与诱发电位具有明显的相关性.[结论] 椎板外冲击负荷通过改变脊髓血流来影响脊髓的功能,并且脊髓血流和诱发电位有明显的相关性.     

Pressure changes in spinal canal and evaluation of spinal cord injuries in spinal section subjected to impact

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骨质疏松性腰椎骨折合并脊髓损伤的手术治疗

目的探讨椎体成形辅助椎弓根螺钉固定治疗骨质疏松性腰椎骨折合并脊髓损伤的临床疗效。方法2006年7月-2007年9月,对7例患者应用此法治疗。平均随访11.6个月（6-20个月）。按ASIA分级标准检查神经功能,用X线片测量伤椎术前、术后后凸畸形的角度和椎体前缘高度进行临床评价。结果7例患者中神经功能由C级恢复到D级4例、恢复到E级1例,由D级恢复到E级2例。伤椎椎体前缘高度压缩率术前为53.00%±9.59%,术后为72.00%±6.70%,丢失4.00%±3.72%（P〈0.01）;后凸畸形角度术前为21.00°±6.57°,术后为8.00°±4.18°（P〈0.01）,丢失2.00°±2.67°（P〈0.05）。7例患者均无骨水泥渗漏,1例出现椎弓根螺钉松动。结论椎体成形辅助椎弓根螺钉固定术是对骨质疏松引起的腰椎骨折合并脊髓损伤的一种有效治疗方法。     

脊柱脊髓开放性损伤21例救治

目的探讨脊柱脊髓开放性损伤的临床特点、治疗及预后情况。方法21例脊柱脊髓开放性损伤患者,男17例,女4例;年龄15~47岁,平均25岁。损伤部位胸脊髓15例,腰脊髓5例,颈脊髓1例。术前ASIA分级A级8例,B级5例,C级6例,D级2例。6例伤口内有异物存留。21例均行急诊手术清创,根据损伤具体情况,行椎管探查、血肿清除、异物取出术。结果术后死亡1例(占4.8%),椎管感染1例(占4.8%),发生脑脊液漏2例(占9.5%)。1例术后脊髓损伤程度加重,2例术后神经功能有不同程度的恢复。术后ASIA分级A级9例,B级4例,C级5例,D级2例,E级1例。结论脊柱脊髓开放性损伤需在充分地术前准备下急诊手术治疗,术前应了解是否有异物存留,手术探查可以减少感染、出血等并发症的发生。     

Pressure ulcers and acute risk factors in individuals with traumatic spinal fractures with or without spinal cord injuries: A prospective analysis of the National Spinal Column/Cord Injury Registry of Iran (NSCIR-IR) data

PurposeTo identify risk factors for developing pressure ulcers (PUs) in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries (SCIs).MethodsData were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran (NSCIR-IR) from individuals with traumatic spinal fractures with or without SCIs, inclusive of the hospital stay from admission to discharge. Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay. The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification. In addition to PU, following data were also extracted from the NSCIR-IR datasets during the period of 2015 – 2021: age, sex, Glasgow coma scale score at admission, having SCIs, marital status, surgery for a spinal fracture, American Spinal Injury Association impairment scale (AIS), urinary incontinence, level of education, admitted center, length of stay in the intensive care unit (ICU), hypertension, respiratory diseases, consumption of cigarettes, diabetes mellitus and length of stay in the hospital. Logistic regression models were used to estimate the unadjusted and adjusted odds ratio (OR) with 95% confidence intervals (CI).ResultsAltogether 2785 participants with traumatic spinal fractures were included. Among them, 87 (3.1%) developed PU during their hospital stay and 392 (14.1%) had SCIs. In the SCI population, 63 (16.1%) developed PU during hospital stay. Univariate logistic regression for the whole sample showed that marital status, having SCIs, urinary incontinence, level of education, treating center, number of days in the ICU, age, and Glasgow coma scale score were significant predictors for PUs. However, further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center, marital status, having SCIs, and the number of days in the ICU. For the subgroup of individuals with SCIs, marital status, AIS, urinary incontinence, level of education, the treating center, the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis. After adjustment in the multivariate model, the treating center, marital status (singles vs. marrieds, OR = 3.06, 95% CI: 1.55 – 6.03, p = 0.001), and number of days in the ICU (OR = 1.06, 95% CI: 1.04 – 1.09, p < 0.001) maintained significance.ConclusionsThese data confirm that individuals with traumatic spinal fractures and SCIs, especially single young patients who suffer from urinary incontinence, grades A-D by AIS, prolonged ICU stay, and more extended hospitalization are at increased risk for PUs; as a result strategies to minimize PU development need further refinement.     

颈部创伤无骨折脱位的颈脊髓损伤

颈脊髓损伤多继发于头颈部创伤引起的颈椎骨折脱位，但也有一部分颈脊髓损伤，经X线检查未见骨折或脱位的征象，由于对其认识不足，往往不能得到正确的诊断和治疗。自1983年4月至2002年4月，我院收治此类患者150例，通过临床资料分析，对临床的相关问题进行讨论。     

Exploring the first pressure injury and characteristics of subsequent pressure injury accrual following spinal cord injury

Context/Objective: Clinicians have guidance on prevention and treatment of pressure injuries, but little is known regarding characteristics of patients who develop additional pressure injuries. Thus, our objective was to explore the first pressure injury and characteristics of individuals who develop subsequent pressure injuries during acute care and inpatient rehabilitation following spinal cord injury.Design: Secondary analysis of longitudinal data from a cohort of adults following initial traumatic spinal cord injury.Setting: Urban acute care hospital and inpatient rehabilitation facilities.Participants: A convenience sample of adults (n = 38) who developed at least one pressure injury during acute care and inpatient rehabilitation.Interventions: Not applicable.Outcome Measures: The primary outcomes were number of additional pressure injuries and stage of care during which they occurred, prior to community discharge.Results: A covariate-adjusted model revealed that participants with ASIA D injury had a 67% decrease in the rate of additional pressure injury incidence compared to participants with ASIA A injury (Rate Ratio = .33, 95% CI [0.13, 0.88]). The severity of the first pressure injury had no significant association with subsequent pressure injury incidence (P = .10).Conclusion: These findings indicated that individuals with greater sensory and motor loss had an increased risk of developing additional pressure injuries compared to individuals with less impairment. These results are meaningful for stakeholders interested in understanding factors associated with developing subsequent pressure injuries during the index rehabilitation stay and provide a foundation for future research in this area.     

下颈椎骨折脱位并脊髓损伤的前路手术治疗

目的探讨前路手术在治疗下颈椎骨折脱位并脊髓损伤中的价值。方法168例下颈椎骨折脱位并脊髓损伤患者均在全麻下行颈前路减压、复位、钛网或自体髂骨植骨及颈椎带锁钢板固定。结果完全复位151例,复位90%以上17例。平均随访80.7个月,颈椎椎间高度和生理曲度维持良好,无钢板螺钉并发症。140例脊髓损伤者神经功能获改善。结论下颈椎骨折脱位并脊髓损伤选择前路手术治疗可获得满意的疗效。     

Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury

ObjectivesIdentifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team.DesignProspective cohort study.SettingA single Level-1 trauma center specialized in SCI care.ParticipantsA cohort of 301 patients with acute TSCI was studied.Outcome measuresThe primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors.ResultsWhen controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1–4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001).ConclusionsPrevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.     

Imaging diagnosis of cervical spine and spinal cord injuries in children

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Cervical spinal canal narrowing and cervical neurological injuries

Cervical spinal canal narrowing can lead to injury of the spinal cord and neurological symptoms including neck pain,headache,weakness and parasthesisas.According to previous and recent clinical researc...