脊髓损伤患者的救治特点及生存状态分析  

Management and survival analysis of patients with spinal cord injury

作　　者：张培训[1] 薛峰[1] 王静[1] 徐海林[1] 张殿英[1] 付中国[1] 姜保国[1] 

机构地区：[1]北京大学人民医院创伤骨科,北京100044

出　　处：《中国骨与关节外科》2009年第2期119-122,共4页Chinese Journal of Bone and Joint Surgery

基　　金：国家十一五支撑计划资助(2007BAI04B00)

摘　　要：目的分析脊髓损伤患者的救治特点及生存状态。方法对2006年12月1日至2007年12月31日62例脊髓损伤患者通过病历查询、现场随访及电话随访的方式获取资料,记录患者的基本情况、受伤后救治情况和经济状况。采用美国脊髓损伤协会(American spinal injury association,ASIA)制定的感觉、运动评定标准和功能独立性评定(functional indepen-dence measure,FIM)对患者的恢复情况进行评分,采用抑郁自评量表(self-rating depression scale, SDS)对患者及其家属进行生存状态评估。用SPSS软件进行统计学分析。结果62例脊髓损伤患者中男60例,年龄16～45岁,平均26.9岁;女2例,年龄24和36岁。高处坠落或重物砸伤42例(占67.75%),交通创伤18例(占29%),摔伤2例(占3.25%)。根据美国脊髓损伤协会ASIA伤残分级标准划分:A级完全损伤33例,(占53.3%); B级不完全损伤25例(占40.3%),C级2例(占3.2%),D级2例(占3.2%)。受伤后送至救治医院的时间为4～28 h,平均11 h。颈椎损伤42例(占68.75%),胸椎损伤20例(占32.25%)。A级损伤的33例患者中,8例行减压内固定手术,6例行减压内固定+自体髂骨植骨术,6例行单纯减压手术,13例采取保守治疗。B级损伤的25例患者中,5例行减压内固定手术,7例行减压内固定+自体髂骨植骨术,4例行单纯减压手术,9例采取保守治疗。4例C级和D级损伤的患者全部采用保守治疗。受伤至手术时间8～32 h,平均10.4 h。手术时间1.5～6 h,平均3.2 h。术后随访时6例患者生活能够自理(占9.67%),44例完全需要护理人员(占70.97%),12例均不同程度地需要护理。62例患者中社会保险覆盖率不足5%。患者受伤后患者的家庭年收入1800～8000元,平均3460元,与受伤前相比家庭总收入平均下降80%以上。结论ASIA伤残分级A级损伤患者首先应重建脊柱的稳定性和降低并发症的发生。B级损伤患者应尽早进行减压手术。脊髓损伤患者主要涉及年轻人,96%的患者�Objective To explore the management and survival of spinal cord injury patients. Methods The information of 62 patients with spinal cord injury from December 1, 2006 to December 31, 2007 were gathered by medical records review, face-to-face interview, and telephone follow-up. The gender, age, marital status, living habits, medical history, injury cause, treatment, time of transportation to the nearest hospital, time span from injury to surgery, classification of surgery, location of spinal injury, injury grading, medical insurance, and survival were recorded and statistically analyzed with SPSS software. Results Sixty patients among 62 were male, and the average age was 26. 9 years; the age of 2 female patients was 24 and 36 years. Fifty-eight patients （93.55%） were married, and 45 cases experienced the disease within 3 years after marriage. The disease causes included falling or pounding （70%） and traffic trauma （28%）. Injuries included complete injuries type A （n =33, 53.3% ）, incomplete type B （n =25, 40. 3% ）, and type C and D （ n = 4, 6. 4% ）. The transportation time to hospitals ranged from 4 to 28 hours （ mean： 11 hours）. The affected segments included cervical segments （n =42, 68.75% ） and thoracic segments （n =20, 32. 25% ）. The types of surgeries were： decompression and internal fixation surgeries （n = 23）, decompression and internal fixation and bone grafting surgeries （n = 31 ）, simple decompression surgeries （n = 6 ）, and conservative treatment （n = 2 ）. The surgeries were applied 8 -32 hours after injuries （mean： 10. 4 hours）. The duration of surgeries was 1.5 -6 hours （mean： 3.2 hours）. Six patients could take care of themselves at follow-up, 44 patients totally depended on other people. The social insurance coverage was less than 5 %. The annual family incomes ranged 1800 to 8000 yuan （ mean ： 3460 yuan）. Fifty-seven patients （92%） had children. Conclusion Most spinal cord injuries occur in young males from low-income fa

关 键 词：脊髓损伤 功能独立性评分 随访 

分 类 号：R651.2[医药卫生—外科学]