Baroudi Makeen, Rezk Anna, Daher Mohammad, Balmaceno-Criss Mariah, Gregoryczyk Jerzy George, Sharma Yatharth, McDonald Christopher L, Diebo Bassel G, Daniels Alan H
Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Department of Orthopedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Injury. 2024 Jun;55(6):111472. doi: 10.1016/j.injury.2024.111472. Epub 2024 Feb 28.
Spinal Cord Injury (SCI) is a condition leading to inflammation, edema, and dysfunction of the spinal cord, most commonly due to trauma, tumor, infection, or vascular disturbance. Symptoms include sensory and motor loss starting at the level of injury; the extent of damage depends on injury severity as detailed in the ASIA score. In the acute setting, maintaining mean arterial pressure (MAP) higher than 85 mmHg for up to 7 days following injury is preferred; although caution must be exercised when using vasopressors such as phenylephrine due to serious side effects such as pulmonary edema and death. Decompression surgery (DS) may theoretically relieve edema and reduce intraspinal pressure, although timing of surgery remains a matter of debate. Methylprednisolone (MP) is currently used due to its ability to reduce inflammation but more recent studies question its clinical benefits, especially with inconsistency in recommending it nationally and internationally. The choice of MP is further complicated by conflicting evidence for optimal timing to initiate treatment, and by the reported observation that higher doses are correlated with increased risk of complications. Thyrotropin-releasing hormone may be beneficial in less severe injuries. Finally, this review discusses many options currently being researched and have shown promising pre-clinical results.
脊髓损伤（SCI）是一种导致脊髓炎症、水肿和功能障碍的病症，最常见的原因是创伤、肿瘤、感染或血管紊乱。症状包括从损伤水平开始的感觉和运动丧失；损伤程度取决于损伤严重程度，如美国脊髓损伤协会（ASIA）评分中所详述。在急性期，受伤后7天内将平均动脉压（MAP）维持在高于85 mmHg是首选；不过，使用去氧肾上腺素等血管加压药时必须谨慎，因为会有肺水肿和死亡等严重副作用。减压手术（DS）理论上可减轻水肿并降低椎管内压力，尽管手术时机仍存在争议。目前使用甲基强的松龙（MP）是因其具有减轻炎症的能力，但最近的研究对其临床益处提出质疑，尤其是在国内和国际推荐上存在不一致。MP的选择因开始治疗的最佳时机存在相互矛盾的证据，以及据报道较高剂量与并发症风险增加相关而变得更加复杂。促甲状腺激素释放激素可能对不太严重的损伤有益。最后，本综述讨论了目前正在研究且已显示出有前景的临床前结果的多种选择。
