Wang Fangyong, Hong Yi
Department of Spine and Spinal Cord Injury, Beijing Bo'ai Hospital, China Rehabilitation Research Center, China ; School of Rehabilitation Medicine, Capital Medical University, China.
J Phys Ther Sci. 2015 Oct;27(10):3049-51. doi: 10.1589/jpts.27.3049. Epub 2015 Oct 30.
[Purpose] To study the characteristics and treatment strategy for patients with paraplegia and lower extremity amputation. [Subjects] Six cases were selected from among the patients admitted to the China Rehabilitation Research Center from 1991 to 2014. The criteria for the six cases were spinal cord injury with amputation immediately or in a short time (1 week) after the trauma. [Methods] General information, clinical diagnosis, treatment, rehabilitation and other data were analyzed. [Results] All the six cases were injured by high energy or complex energy accidents: two cases by falls after high voltage electric shock, one by an oil pipeline explosion, one by the impact of a falling tower crane and received high energy traffic accident injuries (one was hit by a train, and the other was hit by a truck at high speed). All the six cases had thoracic and lumbar vertebral injuries and complete paraplegia. Amputation stump infection occurred in four cases. After comprehensive rehabilitation treatment, patients' functional independence measure (FIM) scores improved significantly, but American Spinal Injury Association (ASIA) scores and ASIA Impairment Scale (AIS) grades showed no significant improvement. [Conclusion] When formulating the clinical treatment and rehabilitation for spinal cord injury with amputation patients, simultaneous consideration of the characteristics of the spinal cord injury and amputation is needed to develop an individualized strategy. For spinal cord injury with limb amputation patients, prostheses should allow the improvement of patients' self-care ability.
[目的] 研究截瘫合并下肢截肢患者的特点及治疗策略。[对象] 选取1991年至2014年在中国康复研究中心住院的患者6例。入选标准为创伤后立即或短时间内(1周)发生脊髓损伤并截肢。[方法] 分析患者的一般资料、临床诊断、治疗、康复等数据。[结果] 6例均为高能或复合能量损伤:2例为高压电击后坠落伤,1例为输油管道爆炸伤,1例为塔吊倒塌撞击伤,2例为高能交通事故伤(1例被火车撞击,1例被高速行驶的卡车撞击)。6例均有胸腰椎损伤并完全性截瘫。4例出现截肢残端感染。综合康复治疗后,患者的功能独立性测量(FIM)评分显著提高,但美国脊髓损伤协会(ASIA)评分及ASIA损伤分级(AIS)未显著改善。[结论] 制定脊髓损伤合并截肢患者的临床治疗及康复方案时,需同时考虑脊髓损伤及截肢的特点,制定个体化策略。对于脊髓损伤合并肢体截肢患者,假肢应有助于提高患者的自我护理能力。