Wuermser Lisa-Ann, Ho Chester H, Chiodo Anthony E, Priebe Michael M, Kirshblum Steven C, Scelza William M
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA.
Arch Phys Med Rehabil. 2007 Mar;88(3 Suppl 1):S55-61. doi: 10.1016/j.apmr.2006.12.002.
This self-directed learning module highlights the basic acute care management of traumatic and nontraumatic spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Acute traumatic SCI is optimally managed in a level 1 trauma center. Decompression of the neural elements, stabilization of the spine, and maintenance of tissue perfusion are fundamental to optimizing outcomes. SCI patients are at high risk of pressure ulcers, venous thromboembolism, stress ulceration, bowel impaction, dysphagia, and pulmonary complications. Physiatric interventions are needed to prevent these complications. Prognostication of neurologic outcome based on early examination is an important skill to aid in creating a rehabilitation plan and to test for efficacy of early interventions. Nontraumatic SCI is an increasing population in rehabilitation centers. Establishing a diagnosis and treatment plan is essential, in conjunction with prevention of complications and early physiatric intervention.
(a) To describe the diagnostic evaluation of traumatic and nontraumatic spinal cord injuries and (b) to summarize the medical, surgical, and physiatric interventions during acute hospitalization for these injuries.
本自主学习模块重点介绍创伤性和非创伤性脊髓损伤（SCI）的基本急性护理管理。它是针对物理医学与康复领域的从业者和学员的自主物理医学教育项目中脊髓损伤医学章节的一部分。急性创伤性脊髓损伤在一级创伤中心进行最佳管理。神经减压、脊柱稳定以及组织灌注的维持对于优化治疗效果至关重要。脊髓损伤患者发生压疮、静脉血栓栓塞、应激性溃疡、肠梗阻、吞咽困难和肺部并发症的风险很高。需要物理医学干预来预防这些并发症。基于早期检查对神经功能预后进行预测是一项重要技能，有助于制定康复计划并检验早期干预的效果。在康复中心，非创伤性脊髓损伤患者的数量在不断增加。结合并发症的预防和早期物理医学干预，建立诊断和治疗计划至关重要。
（a）描述创伤性和非创伤性脊髓损伤的诊断评估，（b）总结这些损伤在急性住院期间的医学、外科和物理医学干预。
