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

Abstract

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

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.

Figures/Tables 12

References 43

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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%)

Clinical Characteristics of Old Patients with Spinal Cord Injury

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项目	60~64岁	65~69岁	70~74岁	≥ 75岁
男性	122	77	43	39
女性	35	35	22	13
手术	147	98	56	40
非手术	10	14	9	12

性别	AIS分级	颈段(n = 242)		胸段(n = 113)		腰段及马尾损伤(n = 31)		合计 (n = 386)
性别	AIS分级	外伤	非外伤	外伤	非外伤	外伤	非外伤	合计 (n = 386)
男(n = 281)		163	31	27	38	10	12
	A	37	3	15	4	1	1	61
	B	17	1	2	6	3	1	30
	C	55	10	5	10	1	5	86
	D	54	17	5	18	5	5	104
女(n = 105)		30	18	13	35	3	6
	A	4	3	4	8	1	2	22
	B	7	1	2	4	0	1	15
	C	5	4	5	10	0	1	25
	D	14	10	2	13	2	2	43

AIS分级	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
A级(n = 22)	4(18.18)	3(13.64)	2(9.09)	2(9.09)	1(4.55)	1(4.55)
B级(n = 15)	7(46.67)	2(13.33)	1(6.67)	1(6.67)	2(13.33)	0(0.00)
C级(n = 25)	5(20.00)	6(24.00)	1(4.00)	3(12.00)	1(4.00)	3(12.00)
D级(n = 43)	10(23.26)	9(20.93)	7(16.28)	4(9.30)	3(6.98)	2(4.65)
合计	26(24.76%)	20(19.05%)	11(10.48%)	10(9.52%)	7(6.67%)	6(5.71%)

性别及分级	外伤	非外伤	χ²值	P值
男性	200	81	24.763	< 0.001
女性	46	59
男性
AIS A级	53	8	9.374	0.002
非AIS A级	147	73
AIS B级	22	8	0.076	0.782
非AIS B级	178	73
AIS C级	61	25	0.004	0.952
非AIS C级	139	56
AIS D级	64	40	7.472	0.006
非AIS D级	136	41
女性
AIS A级	9	13	0.095	0.758
非AIS A级	37	46
AIS B级	9	6	1.863	0.172
非AIS B级	37	53
AIS C级	10	15	0.193	0.660
非AIS C级	36	44
AIS D级	18	25	0.112	0.737
非AIS D级	28	34

项目	男(n = 81)	女(n = 26)
损伤类型
无骨折及脱位	69	16
椎管狭窄	42	9
椎间盘突出	20	7
其他	7	0
有骨折或脱位	12	10
损伤部位
颈	75	19
胸	5	6
腰	1	1
AIS级别
A	5	4
B	11	7
C	31	5
D	34	10

病例	发生脊髓损伤时年龄(岁)	性别	损伤部位	AIS分级	从发病至死亡病程(d)	从开始出现发热症状至死亡的时间(d)	是否气管切开	是否使用呼吸机	使用呼吸机时间(d)
1	78	男	颈	D	83	9	否	是	1
2	63	男	颈	B	1281	13	否	是	11
3	75	男	颈	A	38	10	是	是	6
4	79	女	胸	C	1116	64	否	是	16
5	77	男	颈	C	195	1	否	否	0
6	63	男	颈	C	72	64	是	是	17

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