Prasad V S, Vidyasagar J V, Purohit A K, Dinakar I
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Panjagutta, Hyderbad, India.
Paraplegia. 1995 Jun;33(6):350-3. doi: 10.1038/sc.1995.78.
The spinal cord injury centre of Nizam's Institute of Medical Sciences, Andhra Pradesh, India has been functioning now for 8 months and offers its services to the population of 80 million in the state. To date, 92 patients with a spinal cord injury have been treated; 51 had a thoracolumbar spinal injury. This report presents the results of the management of these 51 patients. Preoperatively both CT and MRI were performed and the radiological findings were correlated with outcome. Twenty five had a thoracic and 26 a lumber location. Twenty nine patients underwent surgical treatment (15 thoracic and 14 lumbar) and the others were treated conservatively (10 thoracic and 12 lumbar). All these operations were carried out within 2 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications for surgery included a delay in admission of more than 3 weeks following trauma, a focus of sepsis, bedsores, a generalised bone disorder such as osteopenia, and medical illnesses. Transpedicular screw-plate fixation was performed in 27 patients, and two patients underwent decompressive laminectomy and interlaminar bone and wire fixation. Delayed spinal decompression was offered to one patient to relieve radiculopathy. Fracture-dislocation spinal injury and those with transection of the spinal cord had the worst outcome, whilst patients with a wedge compression fracture and cord oedema fared better. Operated cases had a shorter hospital stay, and complications of immobilisation were limited. Positive psychological influence of mobilisation and early acclimatisation to the altered style of living with their disability were the most significant outcomes following surgery.
印度安得拉邦尼扎姆医学科学研究所脊髓损伤中心已运营8个月，为该邦8000万人口提供服务。迄今为止，已治疗92例脊髓损伤患者；其中51例为胸腰段脊髓损伤。本报告展示了这51例患者的治疗结果。术前均进行了CT和MRI检查，并将影像学检查结果与预后相关联。25例损伤位于胸椎，26例位于腰椎。29例患者接受了手术治疗（15例胸椎损伤和14例腰椎损伤），其余患者接受保守治疗（10例胸椎损伤和12例腰椎损伤）。所有这些手术均在创伤后2周内进行，对于早期抵达医院的患者给予甲基强的松龙治疗。手术禁忌症包括创伤后入院延迟超过3周、存在脓毒症病灶、褥疮、全身性骨病（如骨质减少）以及内科疾病。27例患者采用椎弓根螺钉钢板固定，2例患者接受了减压性椎板切除术及椎板间植骨和钢丝固定。为1例患者进行了延迟脊髓减压以缓解神经根病。骨折脱位型脊髓损伤和脊髓横断患者预后最差，而楔形压缩骨折合并脊髓水肿患者预后较好。接受手术的患者住院时间较短，固定相关并发症较少。活动及早期适应因残疾而改变的生活方式所带来的积极心理影响是手术后最显著的结果。
