Canton Jérémy, Moutel Laurent, Berrut Gilles, Perrouin-Verbe Brigitte
Service de soins de suite et réadaptation polyvalents et polypathologiques gériatriques, Centre hospitalier de Laval, France.
Pôle hospitalo-universitaire de gérontologie clinique, CHU de Nantes, Nantes, France.
Geriatr Psychol Neuropsychiatr Vieil. 2019 Jun 1;17(2):129-136. doi: 10.1684/pnv.2019.0794.
To compare the neurological evolution, functional improvement, and outcomes after acute hospitalization for elderly patients with newly non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury. Retrospective single-center study conducted with a cohort of patients older than 70 years old with NTSCI and TSCI, admitted between January 2004 and December 2014.in a Rehabilitation center in Nantes France. One hundred and ten patients were included (43 TSCI and 67 NTSCI). Most of the NTSCI had incomplete paraplegia (p<0.001) whereas TSCI had incomplete tetraplegia (p=0.002). Falls were the main cause of traumatic injury. NTSCI and paraplegia had a favourable neurological improvement (p=0.14 and 0.02) whereas TSCI and tetraplegia remained stable (p=0.13 and p=0.007). Therefore functional status remained stable for almost half the patients. Sixty percent of the patient get an assistance or were independent in Katz ADL Index assessment, mostly were NTSCI and paraplegic (p=0.17 and 0.40). About 44% of the patients had normal micturition at discharge, they all had incomplete lesion. Fifteen patients used intermittent catheterization, most of them were TSCI (p=0.02). Private residence was the first place of residence after discharge (47%), 17% goes in nursing home residence. NTSCI were more likely to go home at discharge (p=0.07), to have less comorbidities (p=0.08), length of stay shorter (p=0.053) and a mean age at death higher (p=0.01). Twenty-six percent of the patient deceased, mostly by respiratory problem. The etiology of the lesion and level of neurological impairment influence the neurological evolution, functional improvement and the outcomes of elderly patient with newly SCI. Rehabilitation of elderly SCI must be adapted to enhance neurological and functional recovery.
比较老年非创伤性（NTSCI）和创伤性（TSCI）脊髓损伤患者急性住院后的神经功能演变、功能改善及预后。对2004年1月至2014年12月间收治于法国南特一家康复中心的70岁以上NTSCI和TSCI患者队列进行回顾性单中心研究。共纳入110例患者（43例TSCI和67例NTSCI）。大多数NTSCI患者为不完全性截瘫（p<0.001），而TSCI患者为不完全性四肢瘫（p=0.002）。跌倒为创伤性损伤的主要原因。NTSCI和截瘫患者神经功能改善良好（p=0.14和0.02），而TSCI和四肢瘫患者神经功能保持稳定（p=0.13和p=0.007）。因此，近半数患者的功能状态保持稳定。在Katz日常生活活动指数评估中，60%的患者获得帮助或能够自理，其中大多为NTSCI和截瘫患者（p=0.17和0.40）。约44%的患者出院时排尿正常，均为不完全性损伤。15例患者采用间歇性导尿，其中大多为TSCI患者（p=0.02）。出院后首位居住场所为私人住宅（47%），17%入住养老院。NTSCI患者出院回家的可能性更大（p=0.07），合并症更少（p=0.08），住院时间更短（p=0.053），平均死亡年龄更高（p=0.01）。26%的患者死亡，主要死于呼吸问题。损伤病因及神经功能损害程度影响老年新发SCI患者的神经功能演变、功能改善及预后。老年SCI患者的康复治疗必须进行调整，以促进神经功能和功能恢复。
