脊柱脊髓损伤临床及康复治疗路径实施方案

目的制订脊柱脊髓损伤临床及康复治疗路径。方法总结中国康复研究中心在脊柱脊髓损伤临床及康复治疗领域的经验、患者住院流程及住院费用情况,同时参考ICF Core sets相关内容。结果脊柱脊髓损伤临床及康复治疗路径适用于胸、腰、骶椎损伤并发脊髓神经损伤患者。内容包括急性期的外科治疗(伤后2周内)和亚急性期及后期的脊髓损伤临床及康复治疗(伤后2周～6个月)。急性期的外科治疗路径体现了重建脊柱稳定性及神经减压等核心治疗内容;亚急性及后期脊髓损伤治疗路径体现以康复为主的综合治疗特点。结论本路径的制订及实施基于疾病发展时间进程及脊髓损伤后神经恢复和治疗的阶段性特点,目的是提高医疗服务质量、降低医疗消耗。

Clinic and Rehabilitation Pathway Recommendation for Spine and Spinal Cord Injury

Objective To establish the proposals of clinic and rehabilitation pathway for spine and spinal cord injury.Methods The experiences in clinic and rehabilitation treatment fields,the flow path of admission and the costs of hospitalization for spine and spinal cord injury patients in Chinese Rehabilitation Research Center were retrospectively summarized and analyzed.Related data in International Classification of Functioning,Disability and Health(ICF) core sets were also referred.Results The present proposals were applied to patients suffered from thoracic,lumbar or sacral spine injury with spinal cord injury.The proposals consisted of two parts: the surgical interventions in acute stage(within 2 weeks after injury) and clinic and rehabilitation treatments of spinal cord injury in sub acute and later stages(2 weeks to 6 months after injury).The criteria of surgical interventions in acute stage materialized the core therapies such as reconstruction of spine stability and neural decompression,etc.The criteria of treating spinal cord injury in subacute and later stages demonstrated the characteristic of combined therapy in which rehabilitation was the central element.Conclusion The establishment and implement of the present pathways were based on the time course of disease development and the staging feature of neural recovery and treatment after spinal cord injury.The purpose of this work is to improve the quality of medical service and reduce medical consumption.