老年脊髓损伤患者的临床特点分析

doi:10.3969/j.issn.1006-9771.2021.08.009

摘要/Abstract

摘要：

目的探讨老年脊髓损伤患者的临床特点。方法收集2013年1月1日至2019年12月31日在本院住院康复治疗的386例老年(≥ 60岁)脊髓损伤患者的临床资料。分析患者的性别、年龄、病因、美国脊髓损伤协会残损分级(AIS)及并发症等临床特点。结果老年脊髓损伤患者中,男性多为外伤性损伤(71.17%),女性多为非外伤性损伤(56.19%)。平地跌倒是老年男性(28.83%)和女性(24.76%)脊髓损伤患者的首要病因。肿瘤(19.05%)是老年女性脊髓损伤患者最主要的非外伤性病因。颈段(78.46%)是老年外伤性脊髓损伤中最常见的受损部位;胸段(52.14%)是非外伤性脊髓损伤中最常见的受损部位。老年脊髓损伤患者中最常见的AIS为D级(38.08%),其余依次为C级(28.76%)、A级(21.50%)、B级(11.66%)。椎管狭窄(23.31%)在老年脊髓损伤的病因中占重要地位。老年脊髓损伤患者的最常见并发症依次为神经痛、下肢静脉血栓形成及泌尿系感染。结论平地跌倒是老年脊髓损伤患者的首要病因。随着年龄增长,跌倒在老年脊髓损伤病因中的比例有增高的趋势。采取有效的预防跌倒措施以避免脊髓损伤对老年人非常重要。

关键词: 老年人, 脊髓损伤, 跌倒

Abstract:

Objective To investigate the clinical characteristics of old patients with spinal cord injury. Methods From January 1, 2013 to December 31, 2019, totally 386 old (≥ 60 years) patients with spinal cord injury were enrolled. Their gender, age, etiology, American Spinal Injury Association Impairment Scale (AIS) and complications were analyzed. Results In the old patients with spinal cord injury, traumatic spinal cord injury was more common in males (71.17%) and non-traumatic spinal cord injury was more common in females (56.19%). Fall on level surface was the most important cause of spinal cord injury both in old men (28.83%) and women (24.76%). Tumor (19.05%) was the most common non-traumatic cause of spinal cord injury in old female patients. Cervical segment (78.46%) was the most common site of injury in old traumatic spinal cord injury, while thoracic segment (52.14%) was the most common site of injury in non-traumatic spinal cord injury. Grade D (38.08%) was the most common AIS grade, followed by grades C (28.76%), A (21.50%), and B (11.66%). Spinal canal stenosis (23.31%) played an important role in the etiology of old spinal cord injury. Neuralgia, venous thrombosis of lower extremities and urinary tract infection were the most common complications in old patients with spinal cord injury. Conclusion Fall on level surface is the leading cause of spinal cord injury in old patients, and the proportion of fall in the etiology of old spinal cord injury tends to increase with age. It is important to take effective measures to avoid falling in the old adults to prevent spinal cord injury.

Key words: aged, spinal cord injury, fall

康海琼,周红俊,卫波,刘根林,郑樱,张缨,郝春霞,王一吉,逯晓蕾,袁媛,蒙倩茹. 老年脊髓损伤患者的临床特点分析[J]. 《中国康复理论与实践》, 2021, 27(8): 943-950.

KANG Hai-qiong,ZHOU Hong-jun,WEI Bo,LIU Gen-lin,ZHENG Ying,ZHANG Ying,HAO Chun- xia,WANG Yi-ji,LU Xiao-lei,YUAN Yuan,MENG Qian-ru. Clinical Characteristics of Old Patients with Spinal Cord Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(8): 943-950.

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项目	60~64岁	65~69岁	70~74岁	≥ 75岁	合计
外伤	95(78.51)	51(66.23)	27(64.29)	27(65.85)	200(71.17)
非外伤	26(21.49)	26(33.77)	15(35.71)	14(34.15)	81(28.83)

年龄段(岁)	平地跌倒	交通事故	高处坠落	椎管狭窄	骑车摔倒	椎间盘突出	其他
60~64	28(23.14)	28(23.14)	22(18.18)	8(6.61)	8(6.61)	6(4.96)	21(17.36)
65~69	19(24.68)	12(15.58)	6(7.79)	7(9.09)	9(11.69)	7(9.09)	17(22.08)
70~74	15(35.71)	6(14)	0(0)	7(16.67)	2(4.76)	1(2.38)	11(26.19)
>74	19(46.34)	3(7.32)	2(4.88)	6(14.63)	2(4.88)	3(7.32)	6(14.63)
合计	81(28.83)	49(17.44)	30(10.68)	28(9.96)	21(7.47)	17(6.05)	55(19.57)

项目	60~64岁	65~69岁	70~74岁	≥ 75岁	合计
外伤	16(45.71)	18(51.43)	10(45.45)	2(15.38)	46(43.81)
非外伤	19(54.29)	17(48.57)	12(54.55)	11(84.62)	59(56.19)

年龄段(岁)	平地跌倒	肿瘤	椎管狭窄	脊髓炎或视神经脊髓炎	交通事故	椎间盘突出	其他
60~64	8(22.86)	5(14.29)	3(8.57)	5(14.29)	3(8.57)	3 (8.57)	8(22.86)
65~69	7(20.00)	7(20.00)	4(11.43)	3(8.57)	4(11.43)	0 (0.00)	10(28.57)
70~74	10(45.45)	3(13.64)	3(13.64)	2(9.09)	0(0.00)	3 (13.64)	1(4.55)
>74	1(7.69)	5(38.46)	1(7.69)	0(0.00)	0(0.00)	0(0.00)	6(46.15)
合计	26(24.76)	20(19.05)	11(10.48)	10(9.52)	7(6.67)	6(5.71)	25(23.81)

AIS分级	平地跌倒	交通事故	高处坠落	椎管狭窄	骑车摔倒	椎间盘突出
A级(n = 61)	5(8.20)	21(34.43)	18((29.51)	3(4.92)	3(4.92)	0(0.00)
B级(n = 30)	11(36.67)	3(10.00)	3(10.00)	3(10.00)	4((13.33)	1((3.33)
C级(n = 86)	30(34.88)	13(15.12)	5(5.81)	8(9.30)	7(8.14)	9(10.47)
D级(n = 104)	35(33.65)	12(11.54)	5(4.81)	10(9.62)	7(6.73)	7(6.73)
合计	81(28.83%)	49(17.44%)	30(10.68%)	28(9.96%)	21(7.47%)	17(6.05%)