Meinecke F W
Rehabilitation (Stuttg). 1990 Aug;29(3):163-8.
The aim of spondylodesis is to restore the injured spinal column to its previous shape and stability. In the transverse SCI patient, it entails easier intensive care in case of multiple injury as well as easier general nursing tasks, and greater intensity of physiotherapy in the acute and early phases. Compared to conservative management of the injured spinal column, mobilization is effected some 21 to 39 days earlier in surgical patients, total hospitalization in tetraplegics is shortened by 5 days, and by 34 to 57 days in paraplegic patients. Functionally valuable neurological recovery in primary complete paralysis occurs in 19%/20% of conservative/surgical cases, in primary partial paralysis in 67%/58%. Stabilization of the spinal column however does not at the same time achieve a stabilization of the transverse SCI patient's entire situation--physical, psychological, social. Irrespective of the scope of paralysis, the advantages of a spondylodesis should be considered also in case of total paraplegia. Conservative management retains its importance in cases where surgery is not indicated, or even contraindicated. Comparable results are very rarely achieved outside the specialized centres. Acute cases of SCI should therefore be referred to spinal centres as soon as possible, which for their part have to be able to admit patients 24 hours a day, as well as to provide adequate care until completion of the entire treatment.
脊柱融合术的目的是使受伤的脊柱恢复到先前的形状和稳定性。对于横贯性脊髓损伤患者而言,若发生多处损伤,进行脊柱融合术可使重症监护更便捷,日常护理任务也更轻松,且在急性期和早期可进行强度更大的物理治疗。与对受伤脊柱进行保守治疗相比,接受手术的患者可提前约21至39天开始活动,四肢瘫痪患者的总住院时间缩短5天,截瘫患者缩短34至57天。在原发性完全瘫痪的病例中,保守治疗/手术治疗的患者出现有功能价值的神经恢复的比例分别为19%/20%,在原发性部分瘫痪的病例中这一比例分别为67%/58%。然而,脊柱融合术并不能同时稳定横贯性脊髓损伤患者在身体、心理和社会等方面的整体状况。无论瘫痪程度如何,在完全截瘫的情况下也应考虑脊柱融合术的优势。在不适合甚至禁忌手术的情况下,保守治疗仍具有重要意义。在专业中心之外,很难取得可比的治疗效果。因此,脊髓损伤的急性病例应尽快转诊至脊柱中心,而脊柱中心必须能够每天24小时接收患者,并在整个治疗过程中提供充分的护理。