Zhou Hengxing, Lou Yongfu, Chen Lingxiao, Kang Yi, Liu Lu, Cai Zhiwei, Anderson David B, Wang Wei, Zhang Chi, Wang Jinghua, Ning Guangzhi, Gao Yanzheng, He Baorong, Ding Wenyuan, Wang Yisheng, Mei Wei, Song Yueming, Zhou Yue, Xia Maosheng, Wang Huan, Zhao Jie, Yin Guoyong, Zhang Tao, Jing Feng, Zhu Rusen, Meng Bin, Duan Li, Zhang Zhongmin, Wu Desheng, Cai Zhengdong, Huang Lin, Yin Zhanhai, Li Kainan, Lu Shibao, Feng Shiqing
Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine; Department of Orthopedics, Shandong University Center for Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China.
Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong; Department of Orthopedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China.
Neural Regen Res. 2024 May;19(5):1126-1133. doi: 10.4103/1673-5374.382257.
Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death. China has the largest population of patients with traumatic spinal cord injury. Previous studies of traumatic spinal cord injury in China have mostly been regional in scope; national-level studies have been rare. To the best of our knowledge, no national-level study of treatment status and economic burden has been performed. This retrospective study aimed to examine the epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China at the national level. We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China. Patient epidemiological and clinical features, treatment status, and total and daily costs were recorded. Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program. The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall (annual percentage change, -0.5% and 2.1%, respectively). A total of 10,053 (74.7%) patients underwent surgery. Only 2.8% of patients who underwent surgery did so within 24 hours of injury. A total of 2005 (14.9%) patients were treated with high-dose (≥ 500 mg) methylprednisolone sodium succinate/methylprednisolone (MPSS/MP); 615 (4.6%) received it within 8 hours. The total cost for acute traumatic spinal cord injury decreased over the study period (-4.7%), while daily cost did not significantly change (1.0% increase). Our findings indicate that public health initiatives should aim at improving hospitals' ability to complete early surgery within 24 hours, which is associated with improved sensorimotor recovery, increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
创伤性脊髓损伤可能具有灾难性，可导致永久性残疾甚至死亡。中国创伤性脊髓损伤患者数量最多。此前中国关于创伤性脊髓损伤的研究大多局限于地区范围；国家级研究很少。据我们所知，尚未进行过关于治疗现状和经济负担的国家级研究。这项回顾性研究旨在在国家层面考察中国创伤性脊髓损伤的流行病学和临床特征、治疗现状及经济负担。我们纳入了2013年1月至2018年12月期间受伤并在中国11个省/直辖市的30家医院接受治疗的13465例创伤性脊髓损伤患者。记录了患者的流行病学和临床特征、治疗现状以及总费用和每日费用。使用Joinpoint回归程序通过年度百分比变化评估所有住院患者以及骨科住院患者中创伤性脊髓损伤的百分比趋势和护理费用。所有住院患者以及骨科住院患者中创伤性脊髓损伤的百分比总体上没有显著变化（年度百分比变化分别为-0.5%和2.1%）。共有10053例（74.7%）患者接受了手术。仅2.8%接受手术的患者在受伤后24小时内进行了手术。共有2005例（14.9%）患者接受了大剂量（≥500mg）琥珀酸钠甲泼尼龙/甲泼尼龙（MPSS/MP）治疗；615例（4.6%）在8小时内接受了治疗。在研究期间，急性创伤性脊髓损伤的总费用有所下降（-4.7%），而每日费用没有显著变化（增加1.0%）。我们的研究结果表明，公共卫生举措应旨在提高医院在24小时内完成早期手术的能力，这与感觉运动恢复改善相关，提高与大剂量MPSS/MP相关临床指南的知晓率以减少证据不足的治疗的使用。
