Woolsey R M
Spinal Cord Injury Service, Veterans Administration Medical Center, St. Louis, Missouri.
Crit Rev Neurobiol. 1988;4(2):137-56.
Trauma is the most common cause of spinal cord-related disability. There are approximately 52 new spinal cord injuries per million population per year in the U.S., and about 200,000 persons with post-traumatic paraplegia or quadriplegia require continuing medical care in this country at the present time. Management of the spinal cord-injured patient commences at the moment of injury and continues throughout the entire lifetime of the patient. While there is considerable consensus regarding the management of some problems related to traumatic myelopathy, other treatment concerns, mainly related to spinal fractures, are highly controversial, with a plethora of strongly held opinions, frequently supported by meager factual evidence or none at all. It is not generally recognized that whatever treatment the patient receives during the first days or weeks following injury is of considerably less importance, from a lifelong perspective, than that which occurs over subsequent months. Skillful physical rehabilitation to maximize the functional usefulness of remaining neurological function permits the return of most spinal cord-injured patients to their family and community able to function as an independent person. Paraplegic and quadriplegic patients acquire health risks unique to their condition, mainly related to pressure sore liability and altered bladder function, which requires continual, meticulous attention from the patient and his physician. The sudden transition from being an unimpaired to a permanently paralyzed person is a cataclysmic emotional experience. Unless psychic rehabilitation is undertaken in tandem with physical rehabilitation, a spinal cord-injured patient is likely to become an unhappy social recluse or denizen of a chronic care facility, rather than an independent productive member of his community. Centers dedicated to comprehensive spinal cord care have become generally available and provide optimal care for traumatic myelopathy.
创伤是脊髓相关残疾的最常见原因。在美国，每年每百万人口中约有52例新的脊髓损伤病例，目前该国约有20万人患有创伤后截瘫或四肢瘫痪，需要持续的医疗护理。脊髓损伤患者的治疗从受伤那一刻开始，并贯穿患者的一生。虽然对于一些与创伤性脊髓病相关问题的治疗存在相当大的共识，但其他主要与脊柱骨折相关的治疗问题极具争议，有大量坚定的观点，而这些观点往往缺乏事实依据或根本没有事实依据。人们普遍没有认识到，从患者一生的角度来看，患者在受伤后的头几天或几周内接受的任何治疗，其重要性都远低于随后几个月的治疗。通过巧妙的身体康复以最大限度地发挥剩余神经功能的功能效用，可使大多数脊髓损伤患者回到家庭和社区，能够作为独立个体发挥功能。截瘫和四肢瘫痪患者会面临与其病情相关的独特健康风险，主要与压疮风险和膀胱功能改变有关，这需要患者及其医生持续、细致的关注。从健全人突然转变为永久瘫痪者是一种灾难性的情感体验。除非心理康复与身体康复同步进行，否则脊髓损伤患者很可能会成为不快乐的社会隐士或长期护理机构的居住者，而不是其社区中独立的有生产力的成员。专门提供全面脊髓护理的中心已普遍设立，并为创伤性脊髓病提供最佳护理。
