21世纪脊髓损伤第一部分:一个新的人口统计学
Angelica Alvarez Reyes1, Sruti Bandlamuri1, Travis M Dumont1
1Department of Neurosurgery, Banner University Medical Center, University of Arizona, Tucson, Arizona, USA.
World neurosurgery
|March 21, 2025
概括
最近的宫脊髓损伤 (cSCI) 发生在没有骨折或脱位的老年人中,通常是由于低影响事件. 当前的管理指南可能不适用于这种不断变化的患者人口统计学.
科学领域:
- 神经外科 神经外科
- 创伤外科 手术 创伤外科
- 脊髓损伤研究 脊髓损伤研究
背景情况:
- 现有的急性脊髓损伤指南主要针对来自高冲击创伤的脊髓骨折脱的年轻人.
- 最近的临床观察表明,椎脊髓损伤 (cSCI) 的人口和损伤模式发生了变化.
研究的目的:
- 在一级创伤中心描述当代患有cSCI的患者群体.
- 为了比较当前的cSCI人口统计和伤害类型与在指导方针开发中使用的传统配置文件.
- 为了测试假设,大多数cSCI患者现在落在既定指导原则的范围之外.
主要方法:
- 采用了横截面队列研究设计.
- 对12个月内入院的cSCI患者的人口统计,损伤类型和诊断进行了审查.
- 数据来自1级创伤机构的多个档案系统的交叉引用.
主要成果:
- 在51名确诊的cSCI患者中,82%缺乏脊柱骨折或脱.
- 这些患者年龄较大 (平均年龄62岁),受伤程度较低 (93%),美国脊椎损伤协会 (ASIA) 的评分较低 (98%).
- 相比之下,骨折/脱位的患者年轻 (平均年龄为48岁),有高冲击伤害 (77%) 和更高的ASIA等级 (66%).
- 在没有骨折/脱的cSCI患者中,有98%的人表现出手/手臂的感觉和运动缺陷,而有11%的人表现出骨折脱 (P < 0.0001).
结论:
- 没有骨折或脱位的cSCI患者现在构成了这个创伤中心的大多数.
- 这种人口统计与中枢带综合征一致,表明不同的病理生理学和自然史.
- 将旧指南中的管理原则应用于这种新型患者群体并不简单.
相关概念视频
01:54The Spinal Cord
27.5K
The spinal cord is the body’s major nerve tract of the central nervous system, communicating afferent sensory information from the periphery to the brain and efferent motor information from the brain to the body. The human spinal cord extends from the hole at the base of the skull, or foramen magnum, to the level of the first or second lumbar vertebra.
27.5K
01:16Spinal Cord: Cross-sectional Anatomy
5.7K
The cross-sectional anatomy of the spinal cord offers a detailed view of its complex structure and function within the central nervous system. At the core of the spinal cord lies the gray matter, characterized by its butterfly or "H"-shaped appearance in cross-section. This central region is enveloped by white matter, with the overall structure divided into symmetrical halves by the dorsal median sulcus and the ventral median fissure.
Gray Matter and its Components
Central to the gray matter is...
Gray Matter and its Components
Central to the gray matter is...
5.7K
01:26Spinal Cord
3.6K
The spinal cord, a critical component of the central nervous system, extends from the base of the brainstem to the lumbar region of the vertebral column. It is essential for maintaining physical stability and facilitating communication between the brain and peripheral parts of the body.
3.6K
01:28Traumatic Brain Injury l: Introduction
25
DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...
25
01:14Spinal Cord Injury ll: Pathophysiology
25
Spinal cord injury progresses through two interconnected phases: primary injury and secondary injury.Primary InjuryPrimary injury happens at the moment of trauma and involves immediate mechanical damage to the spinal cord.Compression happens when broken vertebrae, herniated discs, or accumulating blood (such as a hematoma) press directly against the spinal cord, distorting its normal shape and function. In cases of contusion, the cord is bruised by a blunt force (like penetrating injuries or...
25
01:25Secondary Spinal Cord Injury llI: Pathophysiology
52
Early Ischemia and Ionic ImbalanceWithin minutes of spinal cord injury, a secondary cascade begins, progressing over hours to weeks. Vascular damage reduces blood flow, causing ischemia and mitochondrial dysfunction. ATP depletion leads to ion pump failure, membrane depolarization, sodium influx, potassium efflux, and water accumulation, resulting in cellular swelling. Increased intracellular calcium further disrupts mitochondria and accelerates cellular injury.Excitotoxicity and Neuronal...
52