脊柱骨折脱位合并脊髓损伤早期应用甘露醇的体会

脊柱骨折脱位合并脊髓损伤早期应用甘露醇的体会２６４４００山东省文登市整骨医院徐东霞２６４２００山东省威海市疗养院徐东红凡直接暴力或间接暴力作用在正常脊柱和脊髓组织，均可造成脊髓损伤。各种急性脊髓损伤都会产生不同程度的脊髓水肿，水肿可使脊髓所受到的压迫...     

前路重建治疗胸腰椎骨折并脊髓损伤56例分析

目的探讨前路减压重建、钉棒固定治疗胸腰椎骨折并脊髓神经损伤的疗效。方法 2005-06-2010-03运用前路减压治疗合并脊髓损伤的胸腰椎骨折56例。Franke1分级:A级3例,B级16例,C级21例,D级16例。结果 56例均获得随访,术后椎体高度恢复满意,矢状面畸形矫正,骨折全部获得融合,术后神经功能均有不同程度的改善。结论前路手术可在直视下充分减压,矫正矢状面畸形,脊髓神经功能可获得良好恢复。     

AF系统治疗胸腰椎爆裂型骨折并脊髓损伤25例分析

我科2000-03～2006—06应用AF内固定系统治疗胸腰椎爆裂型骨折并脊髓神经损伤25例，经0．5a以上随访，疗效满意，分析如下。 1临床资料 1．1一般资料本组男17例，女8例，年龄17～53岁。受伤原因：高处坠落伤16例，交通事故7例，重物砸伤2例。     

前路减压K-plate钢板治疗胸腰段骨折疗效观察

我科自2002-06以来对19例胸腰段骨折进行前路减压、植骨、K-plate钛合金板内固定，效果良好，报道如下。     

无骨折脱位型颈脊髓损伤合并颈椎病治疗及影响因素

目的　分析无骨折脱位型颈脊髓损伤合并颈椎病的疗效和影响因素。方法　对 30例患者进行回顾性研究。结果　 1合并脊髓型者脊髓功能恢复停滞早于神经根者 ,而且差。但是后期二者脊髓功能均出现恶化。 2手术效果明显优于保守疗法。 3无论合并何型颈椎病 ,远期疗效与手术时机均呈负相关 (P<0 .0 5 )。 4远期疗效与合并脊髓型的病程呈负相关 (P<0 .0 5 )。结论　早期手术是此类损伤首选疗法。合并脊髓型者更应尽早手术。     

改良侧前方减压术治疗脊柱脊髓损伤的探讨

目的 探讨胸腰椎骨折脱位并脊髓损伤手术治疗的效果。方法 采用改良的经后入路侧前方减压术。结果 治疗22例,随访6个月－3年,神经功能较术前改善I－Ⅱ级（按Frankel分级标准）。结论 该改良术式创伤较小,减压部位准确,术中出血少,脊柱稳定性破坏小,手术疗效明显。     

胸腰段脊柱爆裂骨折伴脊髓损伤的治疗

目的　评价不同经后路内固定方法治疗胸腰段脊柱骨折伴脊髓损伤的疗效。方法　回顾性分析 96例经后路长、短节段内固定治疗胸腰段脊柱骨折伴脊髓损伤患者术后神经功能恢复程度、骨折复位愈合效果和并发症的发生情况。结果　短节段组在神经功能恢复程度上与长节段组无显著差异 (P >0 .0 5 ) ,但短节段组的脊柱后凸术后矫正丢失角度明显 <长节段组 ,而且并发症少。结论　后路短节段内固定治疗胸腰段脊柱骨折伴脊髓损伤的效果明显优于后路长节段内固定     

急性脊柱爆裂型骨折合并脊髓损伤的诊治体会

脊柱爆裂型骨折占所有脊柱骨折的14％，以胸腰椎多见，多为不稳定性骨折，常合并脊髓损伤，危及患者生窟警巷留终身残疾。我们收集近两年我院诊治的27例急性脊柱爆裹骨折的CT、MRI资料，结合临床治疗情况进行回顾性分析.     

脊柱骨折并发脊髓损伤患者围手术期48例的护理

脊柱骨折以胸腰段最为常见,并常伤及脊髓,可由间接或直接外力引起,本院2004-06/2007-08收治48例脊柱骨折并发脊髓损伤患者,通过临床实践,围手术期护理在治疗过程中起着重要作用,更是手术成功的关键之一,现将护理心得介绍如下。     

无骨折脱位型颈髓损伤的治疗

[目的]探讨无骨折脱位型颈髓损伤的病理基础、治疗方法的选择和治疗效果.[方法]根据26例无骨折脱位型颈髓损伤患者的MRI检查,按不同的特点分为四种类型,采用不同方法进行治疗.[结果]26例术后随访5个月至9年,平均3.9年.前路手术固定节段均获骨性融合,内固定物无松动、断裂,后路手术无再关门现象,术后MRI检查显示椎管容积扩大,颈髓受压缓解.2例术后脊髓功能无改善,其余患者均有不同程度恢复.[结论]无骨折脱位型颈脊髓损伤应尽早行MRI检查,以明确临床类型.对颈脊髓受压明显者,应尽早采用不类型的手术治疗,对无颈脊髓受压者采用大剂量甲基强的松龙等非手术治疗,亦具有较好的疗效.     

手术结合中药针灸辨证施治对胸腰段椎体骨折合并脊髓损伤的疗效分析

目的:探讨脊柱胸腰段骨折合并脊髓损伤的中西医结合治疗疗效。方法:选择天津市人民医院脊柱科2012年10月~2013年10月脊柱胸腰段骨折合并脊髓损伤的患者28例,其中完全截瘫11例,不完全截瘫17例。分别对其进行西医后路椎弓根钉内固定,结合中医汤药加减及针灸辩证治疗。结果:不完全截瘫治疗后均恢复良好,没有遗留明显肢体功能障碍;完全截瘫病人中4例恢复良好,仅遗留轻微感觉障碍;剩余7例有不同程度的功能障碍.结论:中西医结合治疗脊柱胸腰段骨折合并脊髓损伤可尽可能减少术后创伤反应,促进骨愈合,提高康复效率,且疗效显著,值得探讨应用。     

椎弓根内固定治疗胸腰椎不稳定性骨折38例

目的回顾分析后路AF系统治疗胸腰段不稳定骨折的临床效果和经验,评价AF系统应用价值。方法对38例应用AF系统治疗的胸腰段不稳定性脊柱骨折患者的手术前后的神经功能和X线片进行对比分析。结果患者椎体前后缘剩余高度分别由术前的25%和75%恢复到术后的95%和98%;瘫痪恢复按ASIA分级,C级和D级患者基本恢复正常,B患者平均提高1级,A级无恢复。结论AF系统是一种治疗胸腰段不稳定骨折的有效方法。     

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。     

急性完全性颈髓损伤继发低钠血症的临床观察

目的　总结急性完全性颈髓损伤继发低钠血症的变化规律并探讨其发生机制。方法　回顾分析 35例急性完全性颈髓损伤患者的血尿生化随时间变化规律。结果　本组低钠血症发生率 10 0 % ,低钠血症于伤后 4 .4 9d± 1.17d开始 ,13.6 1d± 3.0 7d达高峰 ,38.89d± 9.6 4 d恢复正常 ,持续时间 34.4 d± 9.5 d,15例 (42 .88% )出院时低钠血症仍未恢复。伤后平均 15 d左右血浆渗透压开始低于正常 ,此后一直持续至出院。结论　严重、顽固的低钠血症是颈髓损伤后极为常见的并发症 ,其发生机制可能与脑耗盐综合征 (CSWS)有关。     

生长相关蛋白在电针治疗大鼠脊髓损伤中的表达及意义

[目的]探讨生长相关蛋白(Gap-43)在电针治疗大鼠脊髓损伤(SCI)中的变化及意义.[方法]以2个月龄Wistar大鼠(96只)为受试对象,随机分为对照组(A组)、损伤组(B组)、治疗对照组(C组)和电流刺激治疗组(D组).B、C、D组于T9处行脊髓全横断,D组予电针治疗.用Western-blot测定各组损伤段脊...     

Venous Thromboembolism After Spinal Cord Injury

Teasell RW, Hsieh JT, Aubut JL, Eng JJ, Krassioukov A, Tu L, for the Spinal Cord Injury Rehabilitation Evidence Review Research Team. Venous thromboembolism after spinal cord injury.

Objective

To review systematically the published literature on the treatment of deep venous thromboembolism after spinal cord injury (SCI).

Data Sources

MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing the treatment of deep venous thromboembolism post-SCI. Randomized controlled trials (RCTs) were assessed for methodologic quality using the Physiotherapy Evidence Database Scale, while non-RCTs were assessed using the Downs and Black evaluation tool.

Study Selection

Studies included RCTs, non-RCTS, cohort, case-control, case series, pre-post, and postinterventional studies. Case studies were included only when no other studies were available.

Data Extraction

Data extracted included demographics, the nature of the study intervention, and study results.

Data Synthesis

Levels of evidence were assigned to the interventions using a modified Sackett scale.

Conclusions

Twenty-three studies met inclusion criteria. Thirteen studies examined various pharmacologic interventions for the treatment or prevention of deep venous thrombosis in patients with SCI. There was strong evidence to support the use of low-molecular-weight heparin in reducing venous thrombosis events, and a higher adjusted dose of unfractionated heparin was found to be more effective than 5000 units administered every 12 hours, although bleeding complications were more common. Nonpharmacologic treatments were also reviewed, but again limited evidence was found to support these treatments.     

Surgical Versus Nonsurgical Treatment of Femur Fractures in People With Spinal Cord Injury: An Administrative Analysis of Risks

Objective

To assess the risks associated with surgical and nonsurgical care of femur fractures in people with spinal cord injury (SCI).

Design

Retrospective cohort study; an analysis of Veterans Affairs (VA) data from the National Patient Care Database.

Setting

Administrative data from database.

Participants

The cohort was identified by searching the administrative data from fiscal years 2001 to 2006 for veterans with a femur fracture diagnosis using the International Classification of Diseases, 9th Revision, Clinical Modification codes. This group was subdivided into those with (n=396) and without (n=13,350) SCI and those treated with and without surgical intervention.

Interventions

Not applicable.

Main Outcome Measures

Rates of mortality and adverse events.

Results

The SCI group was younger with more distal fractures than the non-SCI group. In the non-SCI population, 78% of patients had associated surgical codes compared with 37% in the SCI population. There was higher mortality in the non-SCI group treated nonoperatively. In the SCI population, there was no difference in mortality between patients treated nonoperatively and operatively. Overall adverse events were similar between groups except for pressure sores in the SCI population, of which the nonoperative group had 20% and the operative had 7%. Rates of surgical interventions for those with SCI varied greatly among VA institutions.

Conclusions

We found lower rates of surgical intervention in the SCI population. Those with SCI who had surgery did not have increased mortality or adverse events. Surgical treatment minimizes the risks of immobilization and should be considered in appropriate SCI patients.