Merry W H, Cogbill T H, Annis B L, Lambert P J
Department of Surgery, Gundersen/Lutheran Medical Center, La Crosse, Wisconsin, USA.
Injury. 1996 Jan;27(1):17-20. doi: 10.1016/0020-1383(95)00171-9.
During a 3-year period, 19 patients with incomplete spinal cord injuries caused by blunt trauma were admitted to a single rural referral centre. The mean age was 50 years. Injury mechanisms included falls in eight, road traffic accidents in five, diving mishaps in two, and miscellaneous in four. The level of spinal cord injury was cervical in 11, thoracic in five, and thoracolumbar in three. Initial management included a standard high-dose methylprednisolone protocol for 24 h after injury in eight patients treated since May, 1990. Neurosurgical procedures were performed in 11 patients. There were three deaths, all in patients over 75 years of age with pulmonary complications. Of 16 survivors, 10 demonstrated significant functional neurological improvement by the time of hospital discharge, and 11 by late follow up. Complete recovery occurred in five of the survivors. Complications occurred in 11 patients, including pulmonary (nine), infectious (six), and gastrointestinal (three), but could not be associated specifically with the high-dose steroid protocol. In conclusion, incomplete spinal cord injuries after blunt injury were relatively uncommon in this setting. No significant increase in complications was observed after institution of the high-dose methylprednisolone protocol in May, 1990. However, pulmonary, gastrointestinal, and infectious complications were common. Of the 16 survivors, 11 demonstrated significant functional improvement. Mortality appeared to be related to advanced age and to pulmonary complications.
在3年期间，19例因钝性创伤导致脊髓损伤不完全的患者被收治于一家乡村转诊中心。平均年龄为50岁。损伤机制包括8例跌倒、5例道路交通事故、2例潜水事故以及4例其他情况。脊髓损伤水平为颈椎11例、胸椎5例、胸腰段3例。自1990年5月起，8例患者在受伤后24小时接受了标准的大剂量甲基强的松龙治疗方案。11例患者接受了神经外科手术。有3例死亡，均为75岁以上且伴有肺部并发症的患者。16名幸存者中，10例在出院时神经功能有显著改善，11例在后期随访时有改善。5名幸存者完全康复。11例患者出现并发症，包括肺部并发症（9例）、感染（6例）和胃肠道并发症（3例），但这些并发症与大剂量类固醇治疗方案无明确关联。总之，在这种情况下，钝性损伤后脊髓损伤不完全相对少见。1990年5月采用大剂量甲基强的松龙治疗方案后，未观察到并发症显著增加。然而，肺部、胃肠道和感染并发症很常见。16名幸存者中，11例有显著的功能改善。死亡率似乎与高龄和肺部并发症有关。
