老年人创伤性脊髓损伤研究进展

老年人创伤性脊髓损伤的发病率和人群占比逐年升高,在发达国家已是脊髓损伤的主要受累人群。跌倒是最主要的受伤原因,椎管狭窄发生率增加、脊柱生物力学改变和过伸损伤可能是轻微创伤造成该人群脊髓损伤的发生机制。老年人创伤性脊髓损伤通常要接受早期手术治疗,当存在复杂的并发症、病情不稳定或脊髓损伤较轻,且不伴有明显骨折脱位时,可考虑非手术治疗和积极的康复,但具体手术指征、手术时机等还有争议。与年轻人相比,大部分老年患者表现为颈髓不全损伤,通过治疗和康复有望恢复更好的肢体功能,但生活自理能力恢复差,要监测脊髓损伤康复期间的功能变化并据此调整训练时长和强度等。

Advance in Geriatric Traumatic Spinal Cord Injury(review)

The incidence and proportion of traumatic spinal cord injury in the elderly are increasing year by year,and it has become the main affected population of spinal cord injury in developed countries.Fall is the main cause of injury.The increase of spinal stenosis,the biomechanical changes of the spine and the hyperextension injuries may be the mechanism of spinal cord injury caused by minor trauma in this population.Traumatic spinal cord injury in the elderly usually requires early surgical treatment.When there are complicated comorbidities,unstable vital signs or mild spinal cord injury without major fracture or dislocation,non-surgical treatment and active rehabilitation can be considered.However,the specific indications and timing of surgery are still controversial.Compared with young people,most elderly patients present with incomplete cervical spinal cord injury and are expected to restore better limb function,following poor recovery of self-care ability.It is important to monitor the functional change throughout rehabilitation and adjust the hours and intensity of training accordingly.