Todd N V, Skinner D, Wilson-MacDonald J
Northern Medical Services, Sandyford, Newcastle upon Tyne, NE2 1DJ, UK.
Oxford University Hospitals, Oxford, UK.
Bone Joint J. 2015 Apr;97-B(4):527-31. doi: 10.1302/0301-620X.97B4.34328.
We assessed the frequency and causes of neurological deterioration in 59 patients with spinal cord injury on whom reports were prepared for clinical negligence litigation. In those who deteriorated neurologically we assessed the causes of the change in neurology and whether that neurological deterioration was potentially preventable. In all 27 patients (46%) changed neurologically, 20 patients (74% of those who deteriorated) had no primary neurological deficit. Of those who deteriorated, 13 (48%) became Frankel A. Neurological deterioration occurred in 23 of 38 patients (61%) with unstable fractures and/or dislocations; all 23 patients probably deteriorated either because of failures to immobilise the spine or because of inappropriate removal of spinal immobilisation. Of the 27 patients who altered neurologically, neurological deterioration was, probably, avoidable in 25 (excess movement in 23 patients with unstable injuries, failure to evacuate an epidural haematoma in one patient and over-distraction following manipulation of the cervical spine in one patient). If existing guidelines and standards for the management of actual or potential spinal cord injury had been followed, neurological deterioration would have been prevented in 25 of the 27 patients (93%) who experienced a deterioration in their neurological status.
我们评估了59例脊髓损伤患者神经功能恶化的频率及原因，这些患者均有针对临床过失诉讼的报告。对于神经功能恶化的患者，我们评估了神经功能变化的原因以及该神经功能恶化是否具有潜在可预防性。在所有患者中，27例（46%）出现神经功能变化，20例患者（占神经功能恶化患者的74%）最初并无神经功能缺损。在神经功能恶化的患者中，13例（48%）变为Frankel A级。38例伴有不稳定骨折和/或脱位的患者中有23例（61%）出现神经功能恶化；所有这23例患者神经功能恶化可能均是由于脊柱固定不当或脊柱固定解除不当所致。在27例神经功能发生变化的患者中，25例（23例不稳定损伤患者过度活动、1例患者硬膜外血肿未清除、1例患者颈椎手法操作后过度牵引）的神经功能恶化可能是可避免的。如果遵循现有关于实际或潜在脊髓损伤管理的指南和标准，27例神经功能恶化患者中的25例（93%）的神经功能恶化本可得到预防。
