Swiss Paraplegic Centre, Nottwil, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
J Spinal Cord Med. 2023 Sep;46(5):705-715. doi: 10.1080/10790268.2022.2108645. Epub 2022 Sep 21.
The treatment of pressure injury (PI) stage III and IV in people with spinal cord injury or spinal cord disorder (SCI/D) requires a multidisciplinary and surgical involvement.
This scoping review aims to identify published relevant surgical multidisciplinary treatment approaches, describe the elements and evaluate the effectiveness of the approaches.
We searched PubMed and Medline databases for studies about treatment approaches for people aged ≥18 years with chronic SCI/D and PI stage III or IV over ischium, trochanter or sacrum published between January 1990 and December 2021 in English or German language. Two independent reviewers screened the articles. One reviewer extracted information on study author(s), year of publication, study title, study design, country of origin, sample size as well as data on elements and effectiveness of the approaches.
10 different approaches were described in two retrospective cohort studies, three case series, five discussion papers, one review and one guideline. All approaches included debridement, flap surgery, pressure relief and immobilization as well as infection control. Some approaches described elements such as risk screening (7/10), osteomyelitis treatment (8/10), nutritional therapy (8/10), physiotherapy, occupational therapy and psychology (6/10), spasticity control (7/10), and prevention and education (6/10). Only one study reported on the effectiveness of the approaches.
There are key elements for surgical multidisciplinary treatment approaches. However, due to differences in the content of some of these elements and missing elements in some approaches, comparability is difficult and the effectiveness of the complex approaches remains uncertain.
脊髓损伤或脊髓疾病（SCI/D）患者的压力性损伤（PI）III 期和 IV 期的治疗需要多学科和手术介入。
本范围综述旨在确定已发表的有关 SCI/D 慢性患者和坐骨、转子或骶骨 PI III 或 IV 期的多学科手术治疗方法，描述其要素并评估这些方法的有效性。
我们检索了 PubMed 和 Medline 数据库，以获取 1990 年 1 月至 2021 年 12 月期间以英文或德文发表的关于年龄≥18 岁的慢性 SCI/D 和 PI 坐骨、转子或骶骨 III 或 IV 期患者的治疗方法的研究。两名独立的审查员筛选了文章。一名审查员提取了研究作者、发表年份、研究标题、研究设计、来源国、样本量以及方法的要素和有效性的数据。
在两项回顾性队列研究、三项病例系列研究、五项讨论文件、一项综述和一项指南中描述了 10 种不同的方法。所有方法均包括清创术、皮瓣手术、减压和固定以及感染控制。一些方法描述了风险筛查（7/10）、骨髓炎治疗（8/10）、营养治疗（8/10）、物理治疗、职业治疗和心理学（6/10）、痉挛控制（7/10）以及预防和教育（6/10）等要素。只有一项研究报告了这些方法的有效性。
存在外科多学科治疗方法的关键要素。然而，由于一些要素的内容存在差异，并且一些方法中存在缺失的要素，因此难以进行比较，这些复杂方法的有效性仍不确定。
