Dhakal Gaurav Raj, Bhandari Ravi, Dhungana Siddartha, Poudel Santosh, Gurung Ganesh, Kawaguchi Yoshiharu, Riew K Daniel
National Trauma Center, Kathmandu, Nepal.
Univeristy of Toyama, Toyama, Japan.
Global Spine J. 2019 Oct;9(7):713-716. doi: 10.1177/2192568219833049. Epub 2019 Jun 25.
Epidemiological retrospective study.
To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country.
Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days.
There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients.
Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.
流行病学回顾性研究。
描述在一个资源有限的国家中，接受手术治疗的下颈椎创伤患者的人口统计学特征、手术时机、延迟情况、短期神经功能恢复及并发症。
对2015年12月至2017年8月期间在尼泊尔一家创伤医院就诊的30例连续性下颈椎创伤患者进行回顾性队列分析。根据手术时机将患者分为4组：2天内、3至7天、8至30天和超过31天。
有27例男性和3例女性患者，平均年龄40岁。24例因跌倒受伤，27例患者来自加德满都以外地区。没有患者在最初48小时内接受治疗；只有9例在3至7天内接受治疗，16例在8至30天内接受治疗，5例在一个月后接受治疗。主要延迟因素是资金和手术室可用性。13例患者累及C6C7，其次6例累及C5C6。7例患者有完全性神经功能缺损，18例患者有不完全性缺损。共有46.7%的患者在6个月内神经功能得到改善。完全性缺损患者未观察到神经功能恢复。
我们70%的患者在受伤后1周以上才接受治疗，这在大多数第一世界国家可能被认为是不可接受的。正如预期的那样，这些患者中许多人的治疗结果远比北美那些能早期获得医疗护理和保险的中心所报告的要差。尽管如此，近一半的患者在治疗后神经功能得到改善；因此，手术有望使一些神经功能缺损得到恢复。
