脊髓损伤病人的心理干预

对32例脊髓损伤(SCI)病人入院后1周内采用焦虑自评量表(SAS)、抑郁自评量表(SDS)测评并进行心理干预，即提供优雅的诊疗环境、建立良好的护患关系、做好心理疏导、积极进行康复治疗、为病人分忧解难、重视社会化康复等。出院前1周复查SAS、SDS明显下降。提示针对SCI病人心理障碍的成因，及时做好心理护理干预，可减轻其焦虑心理。     

创伤性上升性脊髓缺血损伤

脊椎损伤后,脊髓损伤平面上升较为少见。作者报告了５例,其中Ｔ１０－１１骨折脱位２例：１例于伤后２周内,截竣平面上升至Ｃ２,呼吸麻痹死亡,１例上升至颈部脊髓,双上肢无力;另３例为Ｔ１２骨折２例,Ｌ３骨折１例：其中截竣平面上升至Ｔ９至１例,Ｔ８者２例。５例患者双下肢皆呈软竣,１例死亡患者尸检见脊髓完整,Ｔ９－１０段脊髓前后动静脉血栓,其向上至Ｃ３,向下至Ｓ１,脊髓前血管、中央血管、髓内小血管多处 栓,     

创伤性脑和脊髓损伤病人的评估与监测

脑外伤1.病理生理 脑外伤是造成各年龄段死亡和伤残的主要原因。据报道,美国每年所发生的15万例与外伤有关的死亡人数中一半是脑外伤,也是造成45岁以下美国人死亡的主要原因。许多脑外伤存活者都留有严重的伤残,每年约有500个幸存者出现癫痫、2000例长期处在植物性生存状态。多达75％的脑外伤病人同时伴有其他各器官系统的严重复合伤。休克、低氧血症和高颅压是造成脑外伤死亡的常见原因。认知和早期处理这些生理紊乱可避免死亡和争得良好的预后。     

脊髓损伤患者合并抑郁焦虑情绪的相关因素分析

目的探讨脊髓损伤患者合并抑郁焦虑情绪的高危因素。方法对298例脊髓损伤患者进行汉密尔顿抑郁焦虑量表问卷调查,并记录相关资料进行分析。结果年龄较小、损伤平面越高、损伤程度越重者的抑郁分值更高;文化程度较低、损伤平面越高、损伤程度越重者的焦虑分值更高。结论临床医生应注意脊髓损伤患者特别是损伤部位较高、损伤程度较重的焦虑抑郁状态,尽早干预和治疗。     

创伤性无骨折脱位型颈脊髓损伤

创伤性无骨折脱位型颈脊髓损伤是一种特殊的脊髓损伤,其X线片、CT、MRI检查并未发现骨折、脱位.过去由于对其认识不足,往往诊断为颈髓休克或颈椎一过性损伤,或误诊为脑血管病变或颅脑损伤,从而延误治疗.本院自1991年8月至1996年8月共收治了颈椎、颈髓损伤129例,其中无骨折脱位型颈髓损伤43例,占33.3%.现报告如下.     

创伤性脊髓损伤合并腹部疾患的临床分析

对不同部位，不同程度的脊髓损伤患者合并腹部脏器损伤或腹部疾患１１例，进行回顾性分析。其中颈髓伤３例，胸髓伤４例，马尾神经伤４例。结果显示颈髓和胸髓伤患者在合并腹部脏器损伤或疾患时，临床症状和体症均被不同程度的掩盖。作者认为：对脊髓损伤应高度警惕同时合并腹部脏器伤。腹部Ｂ超及腹腔穿刺，在早期诊断上有重要意义。对慢性期患腹部疾患时应进行认真仔细的查体是十分必要的     

中国创伤性脊髓损伤患者流行病学特征的Meta分析

【摘要】 目的：通过Meta分析对中国创伤性脊髓损伤（traumatic spinal cord injury,TSCI）患者的流行病学特征进行评价。方法：计算机检索PubMed、The Cochrane Library、Web of TSCIence、万方数据、维普网（vip citation databases,VIP）和中国知网（China national knowledge infrastructure,CNKI）,检索时限均从2017年8月31日～2023年2月28日,收集有关中国地区TSCI流行病学特征及相关并发症和合并伤的研究,对文献所报道的TSCI发病率、年龄特征、男女比例、病因学占比、损伤节段和损伤程度等数据进行提取。由2名研究人员独立检索与筛选文献、提取文献数据,并对纳入研究的文献按照AHRQ（Agency for Healthcare Research and Quality）横断面研究评价标准进行质量评价。采用 Stata 17.0 软件进行单臂研究数据的Meta分析,整合纳入文献中的各项流行病学数据,分析结果由森林图表示。结果：共纳入符合标准的中英文文献21篇,对文献中报道的TSCI患者数据进行Meta合并分析,结果显示,我国TSCI年发病率为0.06‰[95%CI（0.04‰～0.08‰）]。TSCI男性患者多于女性患者,性别比例为（1.86~4.73）∶1,所有患者的平均年龄范围为32.09～53.92岁。中国TSCI的主要病因是高处坠落、交通事故和低处跌倒,其占比分别为30%、31%和25%。中国TSCI患者的主要损伤部位是颈段和胸段,占比分别为55%和21%。TSCI损伤的严重程度按照ASIA分级进行评定,以A级和D级损伤占比最大,分别为30%和38%。中国TSCI患者伴随合并伤的概率为56%[95%CI（45%～67%）],主要是头部损伤和肢体骨折。TSCI后产生并发症的概率31%[95%CI（24%～38%）],以呼吸系统感染和泌尿系感染为主。结论：当前中国TSCI发病率偏高,跌倒和交通事故是其主要病因。损伤节段以颈段为主,损伤程度以ASIA A级和ASIA D级占比最多。超过半数的患者会有身体其他部位的合并伤,近1/3的患者会在TSCI后产生并发症。     

创伤性胸椎间盘突出致脊髓损伤1例报告

正胸腰段脊髓损伤多继发于椎体骨折和脱位,损伤机制多由于椎体脱位或骨折块突入椎管压迫脊髓。创伤性胸椎间盘突出致脊髓损伤在临床上较少见,其发病机制不明确,在临床工作中早期诊断较困难,早期及时诊断及治疗,有助于患者神经功能恢复。2016年4月本院收治外伤后胸椎间盘突出致脊髓损伤1例,随访12个月,报道如下。1临床资料患者,男,55岁,因"高空坠落伤后双下肢不全瘫3 d"于2016年4月29日入院,患者3 d前不     

创伤性脊髓损伤药物治疗和细胞治疗研究进展

脊髓损伤患者的临床预后不良,可导致完全或不完全性瘫痪.脊髓损伤的治疗主要包括手术治疗、药物治疗和康复治疗,但通常临床改善效果不佳.脊髓损伤中最广泛的细胞死亡发生在创伤后数小时内,因此早期干预可能是减少受损脊髓进一步损伤或遭受不可逆性细胞损伤的最有效方法.学者们已经确定了一些进行治疗干预的研究方向,如神经保护、替换丢失的...     

高压氧治疗脊髓损伤疗效观察

从1990年尝试应用高压氧(hyperbaric oxygenation简称HBO)和脊椎切开复位内固定前路或侧前方减压治疗33例脊柱骨折脱位合并脊髓损伤，并和单纯脊椎切开复位内固定前路或侧前方减压的34例脊柱骨折脱位合并脊髓损伤作一疗效对比，现报告如下。     

Inpatient rehabilitation outcomes in neoplastic spinal cord compression vs. traumatic spinal cord injury

Objective: To compare neurological and functional outcomes, and complications of patients with neoplastic vs traumatic spinal cord injury (SCI) after in-patient rehabilitation.Design: This study is a retrospective analysis.Setting: In-patient rehabilitation unit of a tertiary research hospital.Participants: A total of 252 patients with a SCI were included; 43 with neoplastic SCI (mean age: 60.9 ± 15.7 years, 60.5% were males) and 209 with traumatic SCI (mean age: 43.1 ± 16.8 years, 71.3% were males).Outcome measures: Comparisons were made of demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) and Functional Ambulation Categories (FAC) scores, length of stay (LOS), bladder independence, medical comorbidities and complications in both groups.Results: Patients with neoplastic SCI were significantly older than those with traumatic SCI (P < 0.01). No difference was present between the groups in terms of sex and lesion level (P > 0.05). Incomplete SCI was significantly higher in the neoplastic group when compared with the traumatic group (P < 0.01). The LOS was significantly shorter in the neoplastic group than traumatic group (34.8 ± 41.03 vs. 60.02 ± 53.1, P < 0.01). There were no differences in the admission FIM scores (69.3 ± 24.7 vs. 58.7 ± 18.9, P > 0.05), discharge FIM scores (82.1 ± 25.1 vs. 74.02 ± 23.3, P > 0.05) and FIM efficiencies (0.43 ± 0.72 vs. 0.36 ± 0.51, P > 0.05) for the neoplastic and traumatic groups, respectively. However, neoplastic SCI patients demonstrated lower FIM gains compared to traumatic patients (12.9 ± 11.9 vs. 15.4 ± 15.2, P < 0.05). During rehabilitation, urinary tract infection (48.4% vs. 69.4%) and decubitus ulcer (11.6% vs. 35.9%) were significantly more common in the traumatic group than the neoplastic group (P < 0.05).Conclusion: Neoplastic SCI patients who commonly present at rehabilitation units exhibit different characteristics from traumatic SCI patients but the rehabilitation results are similar. Similar functional development can be achieved in a shorter period of time with inpatient rehabilitation in the neoplastic SCI group.     

问题解决疗法对脊髓损伤患者照护者的影响

目的探讨以问题解决疗法为基础的护理干预对脊髓损伤患者照护者负性情绪和问题解决能力的影响,为临床护理提供依据。方法将脊髓损伤患者照护者42人随机分为对照组(22人)和干预组(20人)。对照组给予常规护理,干预组照护者接受问题解决疗法为基础的干预方法,干预时间3个月。结果干预后干预组照护者抑郁得分显著降低,且显著低于对照组(P<0.05,P<0.01);干预后干预组社会问题解决能力(除正性问题定向评分外)显著优于干预前及对照组(P<0.05,P<0.01)。结论问题解决疗法可改善脊髓损伤患者照护者的负性情绪,提高其社会问题解决能力。     

Epidemiological features of traumatic spinal cord injury in Guangdong Province,China

Study design: A retrospective hospital-based study.Objective: To describe the epidemiological profile of traumatic spinal cord injury (TSCI) in Guangdong Province.Setting: Two hospitals within Guangdong Province, China.Methods: Medical records of patients diagnosed with TSCI admitted to Foshan Hospital of Traditional Chinese Medicine and Zhujiang Hospital of South Medical University from 1 January 2011 to 31 December 2015 were retrospectively reviewed. Epidemiological characteristics, such as age, sex, occupation, etiology, neurological level of injury, American Spinal Injury Association Impairment Scale at admission, death and cause of death during the acute hospitalization and concomitant injuries.Results: During the study period, 482 cases were identified. Male-to-female ratio was 3.4:1, with a mean age of 41.5 ± 12.6 years old. The leading cause was falls (49.3%), followed by motor vehicle collisions (MVCs) (34.8%). The most common injury site was the cervical spinal cord, especially C4–C6, accounting for 39.8%.Conclusion: The number of TSCI patients in Guangdong Province is large and is exhibiting a rising trend. The leading causes were falls and MVCs. The low-falls (height < 1 m) group has expanded over this period. With China entering an ageing society, more appropriate preventative measures should be implemented for fall-related injuries among the elderly.     

Epidemiological features of traumatic spinal cord injury in Beijing,China

Objective: To describe epidemiological features of traumatic spinal cord injury (TSCI) and to conduct a comparison with data from 2002.Design: Retrospective research.Setting: China Rehabilitation Research Center (CRRC), Beijing.Methods: Five hundred and ninety patients with TSCI were admitted to the CRRC from 1st January 2011 to 31st December 2019. We collected data on sex, age, marital status, etiology, occupation, neurological level of injury, and the American Spinal Injury Association Impairment Scale on admission, time of injury and treatment.Results: Statistically significant differences were observed between data from 2002 and the present results (P < 0.001). The mean age of patients with TSCI was 46.3 ± 15.5 years, and the male/female ratio was 4.73:1. The incidence of TSCI increased gradually with age and peaked in the 40–49 age group. The most common occupation was worker (28.6%), followed by office clerk (16.8%) and retired (15.4%). Fall from heights (30.8%), followed by traffic accidents (27.6%) and low falls (25.1%), were the leading etiologies of TSCI. A majority of patients (54.9%) had cervical injuries, 91.9% underwent surgical treatment, and the lowest number of injuries were recorded during winter (19.6%).Conclusion: According to the changes in the epidemiological characteristics of TSCI, preventative strategies should be readjusted. We should pay more attention to the risk of low falls of the elderly. The authors recommend that stricter regulatory practices and safety measures should be developed alongside infrastructure improvements to reduce, and perhaps prevent TSCI.     

急性创伤性颈髓损伤患者术前机械通气的危险因素分析

目的：分析急性创伤性颈髓损伤（TCSCI）患者术前机械通气的相关危险因素。方法：将2016年11月至2018年5月期间收治的59例TCSCI患者根据术前是否给予机械辅助通气分为机械通气组（37例）和非机械通气组（22例）。最常见伤因是高处坠落（30例,50.8%）,其次是交通事故（22例,37.3%）,最常见的神经损伤平面是C1-C4（36例,61%）。运用美国脊髓损伤协会（ASIA）损伤程度和ASIA运动得分（AMS）评估受影响的神经系统平面和脊髓损伤的程度,使用创伤严重程度评分（ISS）来评估损伤的严重程度。运用多变量Logistic回归分析TCSCI机械通气的危险因素。并运用ROC曲线评估AMS和ISS在预测机械通气的价值。结果：单变量分析结果显示机械通气组的男性、完全损伤、存在相关损伤的比例均显著高于非机械通气组（P<0.05）。机械通气组的AMS评分显著低于无机械通气组（16.4±10.7和39.1±9.5,P<0.001）,ISS评分显著高于无机械通气组（31.6±8.0和26.5±6.7,P=0.015）。多变量Logistic回归分析结果显示,AMS［OR=3.340,95% CI（1.321,6.242）,P<0.001］和ISS［OR=1.120,95% CI（0.306,3.786）,P<0.001］是预测需要机械通气的显著危险因素。ROC分析结果显示AMS的ROC曲线下面积显著高于ISS（0.899和0.685,P<0.05）。结论：患者入院时的AMS和ISS可以作为早期是否给予机械辅助通气的预测指标。     

Prevalence of postpartum depression and anxiety among women with spinal cord injury

Objective: To examine the prevalence of postpartum depression (PPD) and postpartum anxiety (PPA) in mothers with spinal cord injury (SCI).Design: Retrospective, cross-sectional study.Setting: Online multi-national study.Participants: We surveyed an international sample of 102 women who gave birth following cervical SCI (C1–C8, n = 30), upper thoracic SCI (T1–T6, n = 12) or lower level SCI (T7 & below, n = 60). Participants were primarily from Canada and Sweden, and mean age at childbirth was 30 ± 6 years.Outcome Measures: Subscales from the Pregnancy Risk Assessment Monitoring System (PRAMS) were used to measure PPD (PRAMS-3D) and PPA (PRAMS-2A).Results: PPD and PPA were most prevalent in women with cervical SCI, followed by upper thoracic SCI then lower SCI. Self-reported PPD was more prevalent than clinically diagnosed PPD in women with cervical SCI (P = 0.03) and upper thoracic SCI (P = 0.03). With cervical SCI, 75% of women diagnosed with MDD before pregnancy scored >9 on the PRAMS PPD subscale, indicating clinically relevant PPD. However, only 10% were diagnosed with PPD. Of women with lower SCI diagnosed with MDD before pregnancy, 25% had a clinically relevant score for self-reported PPD; 7% were diagnosed.Conclusions: This is currently the largest study examining PPD and PPA after SCI. Clinicians should be aware that mothers with SCI (particularly high-level SCI) may have increased risk of PPD and PPA. PPD is poorly understood in women with SCI and may even be underdiagnosed. SCI-related risk factors for PPD and PPA should be explored.     

Demographic and clinical characteristics of patients with transverse myelitis and traumatic spinal cord injury: A comparative retrospective study

ObjectivesTo identify the demographic and clinical characteristics of patients with transverse myelitis (TM) and to compare functional status between those patients and a matched group with traumatic spinal cord injury (T-SCI).Study DesignRetrospective study.SettingA tertiary rehabilitation hospitalParticipantsThe demographic and clinical characteristics of 484 T-SCI patients and 25 TM patients were compared. Functional status was further analyzed by matching the two groups.Outcome MeasurementsThe matched patients were compared in terms of motor and sensory functions, bladder and bowel symptoms, ambulation level, the Rivermead Mobility Index, and SCI-related medical complications.ResultsThe mean age of the TM patients was 35.6 years and was similar to that of the T-SCI patients. There were significantly more females in the TM group (P = 0.017). Individuals with TM had fewer cervical injuries (P = 0.032) and a higher rate of paraplegia (P = 0.047) and were more often incomplete (P = 0.009) than those with T-SCI. Sensory function was significantly better in the TM group compared to the matched T-SCI group (P = 0.05). Independent ambulation frequency was higher in the TM patients. The SCI-related complications seen in the TM group were as common as those in the T-SCI group.ConclusionThe TM and T-SCI groups differed in terms of the demographic and clinical characteristics recorded. Additionally, when matched for these differences, functional status was slightly better in the TM group. However, like T-SCI, TM was a significant cause of disability and SCI-related complications were common.     

多中心创伤性颈脊髓损伤流行病学分析

【摘要】 目的：分析2013年~2018年我国多中心创伤性颈脊髓损伤（traumatic cervical spinal cord injury,TCSCI）患者人口学与临床特征的现状和趋势、治疗现状、住院期间费用现状。方法：收集我国13家医院[西安市红会医院、上海市东方医院、天津医科大学总医院、苏州大学附属第一医院、深圳市第二人民医院、上海市第一人民医院、秀山县人民医院、西安交通大学第一附属医院、西安一四一医院（现西安交通大学第一附属医院东院区）、成都大学附属医院、金湖县人民医院、首都医科大学宣武医院、井陉县医院]中TCSCI住院患者的病历资料,包括：性别、年龄、职业、致伤原因、损伤节段、损伤程度、美国脊髓损伤协会残障（ASIA impairment scale,AIS）分级、治疗方式选择、减压手术时间窗、类固醇皮质激素药物[甲泼尼龙琥珀酸钠（methylprednisolone sodium succinate,MPSS）/甲基强地松龙（methylprednisolone,MP）]的使用时间窗。收集患者在住院期间医疗费用和住院时长。统计分析以上数据资料的现状,计算年度变化百分比（annual percentage change,APC）来分析患者人口学和临床特征在6年间的变化趋势;分析患者治疗方式和医疗支出的现状。结果：共纳入2102例TCSCI患者,2013~2018年TCSCI数量呈逐年增加趋势（APC=16.9%,95%CI：10.2~24.1,P＜0.01）,患者的平均年龄（APC=1.7%,95%CI：1.0~2.4,P＜0.01）和老年患者所占比例（APC=12.5%,95%CI：6.0~19.3,P＜0.01）呈上升趋势。男性占79.9%,最常见的职业是农民（32.8%）;常见的致伤原因前三位为：摔倒（36.7%）、交通事故（30.0%）、高坠（18.4%）。最常见的损伤节段为C4水平（26.8%）,其次是多节段损伤（24.4%）和C5水平（18.9%）,有超过半数的患者为不完全性四肢瘫痪（67.8%）和AIS D级（51.9%）,截瘫（包括完全性和不完全性）所占比例呈下降趋势。66.0%的患者接受了减压手术治疗,但其中只有2.0%的患者是在伤后24h内进行的手术。有18.2%的患者接受了大剂量MPSS/MP治疗,其中有34.2%的患者在伤后8h内使用;伤后24h以后仍使用大剂量MPSS/MP的有173例,占使用大剂量MPSS/MP患者的45.2%。急性和亚急性期住院总费用平均为6.93万元,日均费用平均为0.42万元。男性患者住院期间总医疗费用和日均医疗费用的均值高于女性。在不同的损伤程度分组中,完全性四肢瘫痪患者住院期间医疗费用最高;在不同AIS分组中,AIS A级的患者住院期间医疗费用最高。结论：TCSCI患者的数量、平均年龄、老年患者占比均在逐年上升,在TCSCI患者的实际临床治疗中,减压手术时间窗、类固醇皮质激素的用法用量等与指南建议并不完全一致。