The acute and chronic management of spinal cord injury
The acute and chronic management of spinal cord injury
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DOI：
10.1016/s1072-7515(00)00240-4
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发表时间：
2000-05-01
影响因子：
5.2
通讯作者：
Levi, ADO
中科院分区：
文献类型：
--
作者：
Belanger, E;Levi, ADO
脊髓损伤（SCI）对患者及其家属来说都是一种毁灭性的伤害。在过去的几十年里，护理质量的提高部分反映了专注于脊髓损伤患者的急性治疗和康复的专业医疗中心，并且有最好的设备来提供这些患者所需的服务。由于脊髓损伤急性期和慢性期的生存率提高，脊髓损伤的患病率正在稳步上升。急性治疗的进展包括更复杂的院前护理，及时识别脊髓损伤的迹象，更安全的运输方法，以及现场和急诊科的积极复苏。在疾病的慢性阶段的治疗方面，如脊髓空洞的手术治疗、晚期创伤后畸形和疼痛控制方面已经取得了进展。生存率的提高促使医疗保健行业制定提高生活质量的策略，从更轻的轮椅到为脊髓损伤患者制定生育计划。SCI的发生机制是不断进化的。随着工业化的发展，机动车事故已成为脊柱损伤的主要原因。暴力导致的脊髓损伤正在急剧上升，这体现在人身攻击造成的伤害比例上，包括穿透性伤害，如枪击和刀伤。体育相关的伤害，包括足球、骑马和曲棍球，最近受到了媒体的关注。由潜水、雪地摩托事故和跳伞引起的娱乐性伤害是新受伤患者的持续来源。由于在陆地和空中对极限速度的渴望，我们预计在娱乐活动中会出现新的伤害，比如单板滑雪、水上飞机等。鼓励儿童和年轻人改变危险行为的预防项目最有可能降低脊髓损伤的发生率。其中包括但不限于，由美国神经外科医生协会和神经外科医生大会赞助的“思考第一”项目，以及最初在佛罗里达州北部开发的“脚第一，第一次”项目，该项目鼓励水爱好者先跳进未知的水域。司机诱拐课程和警察巡逻，逮捕在药物或酒精影响下驾驶车辆的司机，也有助于减少这些不幸事件。最后，对手枪和攻击性武器的管制可以减少故意和意外伤害的数量。确定脊髓损伤患者入院时的预后仍然具有挑战性。临床医生使用神经学检查、年龄、脊髓MRI表现和其他临床数据，就特定损伤的预期结果向患者和家属提供咨询。对于大多数不完全性脊髓损伤患者来说，一定程度的恢复是正常的，但当患者出现完全性损伤时，恢复活动功能的机会仍然很小。3
Spinal cord injury (SCI) remains a devastating injury for both patients and their families. Improvements in the quality of care over the last few decades partially reflect specialized medical centers that focus on the acute treatment and rehabilitation of patients with SCI and are best equipped to provide the magnitude of service these patients require. The prevalence of SCI is increasing steadily because of improved survival in both the acute and chronic stages of the disease. Advances in acute treatment include more sophisticated prehospital care, prompt recognition of the signs of SCI, safer transportation methods, and active resuscitation both in the field and in the emergency department. Improvements in the treatment of the chronic stages of the disease, such as the surgical management of syringomyelia, late posttraumatic deformity, and pain control, have been achieved. Increased survival has prompted the health care industry to develop strategies to enhance the quality of life, with improvements ranging from lighter wheelchairs to the development of fertility programs for patients with SCI. The mechanism of SCI is in constant evolution. With industrialization, motor vehicle accidents have become the leading cause of spinal trauma. SCI because of violence is on a dramatic rise, as manifested by the proportion of individuals injured by assault, including penetrating injuries such as gunshot and knife wounds. Sports-related injuries, which include football, horseback riding, and hockey, have received recent media attention. 1 Recreational injuries from diving, snowmobile accidents, and parachuting are a constant source of newly injured patients. Because of the desire for extreme speed, both on land and in the air, we expect the emergence of new injuries from recreational activities, such as with snowboarding, water craft, and others.Preventive programs, which encourage children and young adults to modify risky behaviors, have the greatest prospect of reducing the incidence of SCI. These include, but are not limited to, the Think First program sponsored by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, 2 and the Feet First, First Time program initially developed in northern Florida, which encourages water enthusiasts to jump feet first into unknown waters. Driver’seducation courses and police patrol, to arrest drivers in command of vehicles while under the influence of drugs or alcohol, also can help decrease these unfortunate events. Finally, regulation of handguns and assault weapons can reduce the number of intentional and accidental injuries. Determining the prognosis for SCI patients on admission remains challenging. The clinician uses neurologic examination, age, MRI appearance of the cord, and other clinical data to counsel patients and families on the expected outcomes for a specific injury. Some recovery is the rule for most patients who enter the hospital with an incomplete SCI, but when patients present with complete injuries, the chance of regaining ambulatory function remains slim. 3