2007年天津市区外伤性脊髓损伤流行病学调查
摘要
目的探讨2007年天津市区外伤性脊髓损伤的流行病学特点。
资料与方法对2007年天津市区主要三级甲等医院住院的外伤性脊髓损伤病例进行回顾性分析(排除既往存在神经肌肉系统疾病及精神疾病的患者),调查内容包括医院名称、患者性别、年龄、民族、居住地址、损伤日期、入院日期、出院日期、职业、损伤原因、合并损伤、ASIA (American spinal injury association)评分、脊髓损伤部位、是否行MRI检查、手术与否及手术日期和手术方式、并发症、所用药物治疗及康复治疗及预后情况。使用均数比较等统计学方法进行处理。
结果
1.发病率2007年天津市区外伤性脊髓损伤发病率为17.9人／100万人。
2.人口统计学资料男性57例,女性16例。平均年龄51.34岁,40-59岁年龄组占52.1%,60岁以上年龄组占26%。无职业患者占64.4%,工人占20.5%。
3.损伤原因和部位(1)损伤原因主要是跌倒(占42.5%)、交通事故(占35.6%),还有高空坠落、重物砸伤等。不同性别患者主要损伤原因有所不同,男性以跌倒为主,女性以交通事故为主。(2)脊髓损伤常合并脊椎骨折、头面外伤、肋骨骨折和四肢骨折等损伤。(3)颈髓损伤占83.6%,其中又以颈5脊髓损伤多见,胸髓损伤占9.6%(胸10脊髓损伤占5.5%),腰髓损伤占6.8%(腰2脊髓损伤占5.5%)。不同损伤部位患者的年龄和损伤原因比例不同,颈髓损伤患者平均年龄53.97岁,跌倒和交通事故是主要致伤原因；而胸腰髓损伤平均年龄38岁,主要致伤原因是重物砸伤、交通事故和高空坠落。同时颈髓和腰髓以D级损伤为主,胸髓则全部是A级损伤。
4.治疗与并发症(1)保守治疗：患者给予制动、脱水及营养神经治疗,部分患者应用神经节苷脂治疗。手术治疗：35例患者接受手术治疗,视损伤情况行后路椎体复位椎板切除术和／或内固定术、后路椎管成形术、前路椎体次全切除术或椎间盘切除植骨融合内固定术以及前后路联合手术。8小时内就诊患者应用甲强龙冲击治疗(NASCISⅡ方案)。(2)并发症：22例患者出现并发症,以呼吸系统、泌尿系统和电解质紊乱并发症多见,主要发生在年龄大、脊髓损伤运动评分低的患者。
5.预后通过电话进行患者随访。失访23人,死亡6人(均发生在颈脊髓损伤患者),年龄大、ASIA运动评分低的患者死亡风险高。随访的44例患者,没有进一步行康复治疗。用FIM (Functional Independence Measure)评分中的自理能力、括约肌控制、转移及行动评分评价,ASIA分级D级患者恢复的程度与是否进行手术治疗无关。
结论
1.天津市区脊髓损伤发病率为17.9人／100万人。
2.患者的年龄较高,特别是60岁以上患者比例较高。颈髓损伤患者的平均年龄高于胸腰髓损伤患者。
3.跌倒为主要致伤原因。
4.颈脊髓损伤是最常发生的脊髓损伤。
5.并发症以呼吸系统并发症、泌尿系统并发症和低钠血症常见,主要发生在年龄大、ASIA运动评分低的患者。低钠血症全部发生在颈脊髓损伤。
6. ASIA分级中的D级损伤患者可行保守治疗。
7.脊髓损伤死亡率8.2%,年龄大、ASIA运动评分低的患者死亡的风险增加。
Objective To investigate the epidemiology characteristics of traumatic spinal cord injury(TSCI) in urban of Tianjin in 2007.
Methods This research retrospectively reviewed hospital records on all patients with traumatic SCI in urban of Tianjin in 2007, except for neuromuscular diseases and psychiatric disorders. This context investigate hospital, patient's gender, age, nation, address, date of injury, date of admission, date of discharge, occupation, cause, combined injuries, ASIA(American spine injury association) impairment scale, injurying level, treatment, stay of length,complication and follow up by telephone.The results are compiled and analyzed by SPSS16.0.
Results
1. Incidence There are 73 patients in 2007.The incidence of SCI in Tianjin is 17.9/million.
2. Demographics Mean age is 51.34±14.597 years. Male:Female is 3.56:1.
3. Injuries Falls、motor vehicle accidents (MVC) were the main causes of TSCI. Injury for different in sex, fall in dominated male, but female dominated by traffic accidents. Often associated with vertebral fractures,head and face trauma,rib fractures and limb fractures. Cervical spinal cord injuries (CSCI) are common. Thoracic and lumbar are followed.Central cord syndrome is more common in the incomplete SCI.Falls and MVC are the main cause of CSCI,mean age is 53.97 years; Thoracolumbar spinal cord injury's mean age is 38 years, traffic accidents and work related injuries are the main causes. Incomplete injuries were predominant in cervical and lumbar. but 100% complete injury in thoracic.
4. Treatment and complications 35 patients received surgical treatment, depending on the individual injuries implementing vertebrae reduction and posterior vertebral laminectomy and/or internal fixation,posterior laminoplasty,anterior corpectomy or discectomy and fusion and fixation surgery,combined anterior and posterior. Patients within 8 hours apply methylprednisolone therapy (NASCISⅡprogram) and part of patients apply ganglioside treatment.22 patients with complications, respiratory, urinary and electrolyte disorders more common complications, mainly in older, lower spinal cord injury in motor score of patients.
5. Prognosis Patients were followed up by telephone. Lost 23. All patients were discharged at home or geracomium, no further treatment at the rehabilitation center. Follow-up of 44 patients with FIM (Functional Independence Measure) score of self-care ability, sphincter control, transfer and action score evaluation, patients with grade D recover well.
Conclusion
1. The incidence of spinal cord injuries is 17.9/million in urban of Tianjing.
2. Age of patients with spinal cord injury is older, especially in the higher proportion of patients aged over 60 years. The average age of patients with cervical spinal cord injury is older than thoracolumbar spinal cord injury patients.
3. Fall is the leading cause.
4. CSCI are common in the TSCI. Falls and MVC are the main cause of CSCI. Work related injuries and MVC are the main causes of thoracolumbar spinal cord injury.
5. Respiratory complications, urinary complications and hyponatremia are common of complications. Hyponatremia have occurred in CSCI.Complications are common in the olders and patients with lower motor scores of ASIA.
6. Patients with D grades use conservative treatment.
7. Mortality of SCI was 8.2%.The older and patients witn lower motor scores of ASIA have higher mortality.
资料与方法对2007年天津市区主要三级甲等医院住院的外伤性脊髓损伤病例进行回顾性分析(排除既往存在神经肌肉系统疾病及精神疾病的患者),调查内容包括医院名称、患者性别、年龄、民族、居住地址、损伤日期、入院日期、出院日期、职业、损伤原因、合并损伤、ASIA (American spinal injury association)评分、脊髓损伤部位、是否行MRI检查、手术与否及手术日期和手术方式、并发症、所用药物治疗及康复治疗及预后情况。使用均数比较等统计学方法进行处理。
结果
1.发病率2007年天津市区外伤性脊髓损伤发病率为17.9人／100万人。
2.人口统计学资料男性57例,女性16例。平均年龄51.34岁,40-59岁年龄组占52.1%,60岁以上年龄组占26%。无职业患者占64.4%,工人占20.5%。
3.损伤原因和部位(1)损伤原因主要是跌倒(占42.5%)、交通事故(占35.6%),还有高空坠落、重物砸伤等。不同性别患者主要损伤原因有所不同,男性以跌倒为主,女性以交通事故为主。(2)脊髓损伤常合并脊椎骨折、头面外伤、肋骨骨折和四肢骨折等损伤。(3)颈髓损伤占83.6%,其中又以颈5脊髓损伤多见,胸髓损伤占9.6%(胸10脊髓损伤占5.5%),腰髓损伤占6.8%(腰2脊髓损伤占5.5%)。不同损伤部位患者的年龄和损伤原因比例不同,颈髓损伤患者平均年龄53.97岁,跌倒和交通事故是主要致伤原因；而胸腰髓损伤平均年龄38岁,主要致伤原因是重物砸伤、交通事故和高空坠落。同时颈髓和腰髓以D级损伤为主,胸髓则全部是A级损伤。
4.治疗与并发症(1)保守治疗：患者给予制动、脱水及营养神经治疗,部分患者应用神经节苷脂治疗。手术治疗：35例患者接受手术治疗,视损伤情况行后路椎体复位椎板切除术和／或内固定术、后路椎管成形术、前路椎体次全切除术或椎间盘切除植骨融合内固定术以及前后路联合手术。8小时内就诊患者应用甲强龙冲击治疗(NASCISⅡ方案)。(2)并发症：22例患者出现并发症,以呼吸系统、泌尿系统和电解质紊乱并发症多见,主要发生在年龄大、脊髓损伤运动评分低的患者。
5.预后通过电话进行患者随访。失访23人,死亡6人(均发生在颈脊髓损伤患者),年龄大、ASIA运动评分低的患者死亡风险高。随访的44例患者,没有进一步行康复治疗。用FIM (Functional Independence Measure)评分中的自理能力、括约肌控制、转移及行动评分评价,ASIA分级D级患者恢复的程度与是否进行手术治疗无关。
结论
1.天津市区脊髓损伤发病率为17.9人／100万人。
2.患者的年龄较高,特别是60岁以上患者比例较高。颈髓损伤患者的平均年龄高于胸腰髓损伤患者。
3.跌倒为主要致伤原因。
4.颈脊髓损伤是最常发生的脊髓损伤。
5.并发症以呼吸系统并发症、泌尿系统并发症和低钠血症常见,主要发生在年龄大、ASIA运动评分低的患者。低钠血症全部发生在颈脊髓损伤。
6. ASIA分级中的D级损伤患者可行保守治疗。
7.脊髓损伤死亡率8.2%,年龄大、ASIA运动评分低的患者死亡的风险增加。
Objective To investigate the epidemiology characteristics of traumatic spinal cord injury(TSCI) in urban of Tianjin in 2007.
Methods This research retrospectively reviewed hospital records on all patients with traumatic SCI in urban of Tianjin in 2007, except for neuromuscular diseases and psychiatric disorders. This context investigate hospital, patient's gender, age, nation, address, date of injury, date of admission, date of discharge, occupation, cause, combined injuries, ASIA(American spine injury association) impairment scale, injurying level, treatment, stay of length,complication and follow up by telephone.The results are compiled and analyzed by SPSS16.0.
Results
1. Incidence There are 73 patients in 2007.The incidence of SCI in Tianjin is 17.9/million.
2. Demographics Mean age is 51.34±14.597 years. Male:Female is 3.56:1.
3. Injuries Falls、motor vehicle accidents (MVC) were the main causes of TSCI. Injury for different in sex, fall in dominated male, but female dominated by traffic accidents. Often associated with vertebral fractures,head and face trauma,rib fractures and limb fractures. Cervical spinal cord injuries (CSCI) are common. Thoracic and lumbar are followed.Central cord syndrome is more common in the incomplete SCI.Falls and MVC are the main cause of CSCI,mean age is 53.97 years; Thoracolumbar spinal cord injury's mean age is 38 years, traffic accidents and work related injuries are the main causes. Incomplete injuries were predominant in cervical and lumbar. but 100% complete injury in thoracic.
4. Treatment and complications 35 patients received surgical treatment, depending on the individual injuries implementing vertebrae reduction and posterior vertebral laminectomy and/or internal fixation,posterior laminoplasty,anterior corpectomy or discectomy and fusion and fixation surgery,combined anterior and posterior. Patients within 8 hours apply methylprednisolone therapy (NASCISⅡprogram) and part of patients apply ganglioside treatment.22 patients with complications, respiratory, urinary and electrolyte disorders more common complications, mainly in older, lower spinal cord injury in motor score of patients.
5. Prognosis Patients were followed up by telephone. Lost 23. All patients were discharged at home or geracomium, no further treatment at the rehabilitation center. Follow-up of 44 patients with FIM (Functional Independence Measure) score of self-care ability, sphincter control, transfer and action score evaluation, patients with grade D recover well.
Conclusion
1. The incidence of spinal cord injuries is 17.9/million in urban of Tianjing.
2. Age of patients with spinal cord injury is older, especially in the higher proportion of patients aged over 60 years. The average age of patients with cervical spinal cord injury is older than thoracolumbar spinal cord injury patients.
3. Fall is the leading cause.
4. CSCI are common in the TSCI. Falls and MVC are the main cause of CSCI. Work related injuries and MVC are the main causes of thoracolumbar spinal cord injury.
5. Respiratory complications, urinary complications and hyponatremia are common of complications. Hyponatremia have occurred in CSCI.Complications are common in the olders and patients with lower motor scores of ASIA.
6. Patients with D grades use conservative treatment.
7. Mortality of SCI was 8.2%.The older and patients witn lower motor scores of ASIA have higher mortality.
引文
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[2]Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury:what learns a worldwide literature survey?[J]. Spinal Cord, 2006,44:523-9.
[3]Pickett GE, Campos-Benitez M, Keller JL, et al. Epidemiology of traumatic spinal cord injury in Canada[J]. Spine (Phila Pa 1976),2006,31:799-805.
[4]Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury[J]. Spine (Phila Pa 1976),2001,26:S2-12.
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[9]Ahoniemi E, Alaranta H, Hokkinen EM, et al. Incidence of traumatic spinal cord injuries in Finland over a 30-year period[J]. Spinal Cord,2008,46:781-4.
[10]Leal-Filho MB, Borges G, Almeida BR, et al. Spinal cord injury: epidemiological study of 386 cases with emphasis on those patients admitted more than four hours after the trauma[J]. Arq Neuropsiquiatr,2008,66:365-8.
[11]Karacan I, Koyuncu H, Pekel O, et al. Traumatic spinal cord injuries in Turkey:a nation-wide epidemiological study[J]. Spinal Cord, 2000,38:697-701.
[12]Fisher CG, Noonan VK, Dvorak MF. Changing face of spine trauma care in North America[J]. Spine (Phila Pa 1976),2006,31:S2-8; discussion S36.
[13]Jackson AB, Dijkers M, Devivo MJ, et al. A demographic profile of new traumatic spinal cord injuries:change and stability over 30 years[J]. Arch Phys Med Rehabil,2004,85:1740-8.
[14]李建军,周红俊,洪毅,等.2002年北京市脊髓损伤发病率调查[J].中国康复理论与实践,2004,10：412-413.
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[17]Brotherton SS, Krause JS, Nietert PJ. Falls in individuals with incomplete spinal cord injury [J]. Spinal Cord,2007,45:37-40.
[18]DeVivo MJ, Vogel LC. Epidemiology of spinal cord injury in children and adolescents[J]. J Spinal Cord Med,2004,27 Suppl 1:S4-10.
[19]Chiu WT, Lin HC, Lam C, et al. Review paper:epidemiology of traumatic spinal cord injury:comparisons between developed and developing countries[J]. Asia Pac J Public Health,2010,22:9-18.
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[22]郝春霞,李建军,周红俊,等.1264例住院脊髓损伤患者的流行病学分析[J].中国康复理论与实践,2007：1011-1013.
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[27]Macciocchi S, Seel RT, Thompson N, et al. Spinal cord injury and co-occurring traumatic brain injury:assessment and incidence[J]. Arch Phys Med Rehabil,2008,89:1350-7.
[28]Burney RE, Maio RF, Maynard F, et al. Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America[J]. Arch Surg,1993,128:596-9.
[29]Rosso A, Brazinova A, Janciak I, et al. Severe traumatic brain injury in Austria II:epidemiology of hospital admissions[J]. Wien Klin Wochenschr, 2007,119:29-34.
[30]Crane DA, Jaffee KM, Kundu A. Intractable pruritus after traumatic spinal cord injury[J]. J Spinal Cord Med,2009,32:436-9.
[31]Yezierski RP. Spinal cord injury pain:spinal and supraspinal mechanisms [J]. J Rehabil Res Dev,2009,46:95-107.
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[10]李建军,周红俊,洪毅,等.2002年北京市脊髓损伤发病率调查[J].中国康复理论与实践,2004,10：412-413.
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[1]French DD, Campbell RR, Sabharwal S, et al. Health care costs for patients with chronic spinal cord injury in the Veterans Health Administration[J]. J Spinal Cord Med,2007,30:477-81.
[2]Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury:what learns a worldwide literature survey?[J]. Spinal Cord, 2006,44:523-9.
[3]Pickett GE, Campos-Benitez M, Keller JL, et al. Epidemiology of traumatic spinal cord injury in Canada[J]. Spine (Phila Pa 1976),2006,31:799-805.
[4]Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury[J]. Spine (Phila Pa 1976),2001,26:S2-12.
[5]胥少汀.脊柱脊髓损伤的临床回顾与研究方向[J].中国脊柱脊髓杂志,2005：261-263.
[6]O'Connor PJ. Prevalence of spinal cord injury in Australia[J]. Spinal Cord, 2005,43:42-6.
[7]Dahlberg A, Kotila M, Leppanen P, et al. Prevalence of spinal cord injury in Helsinki[J]. Spinal Cord,2005,43:47-50.
[8]Rahimi-Movaghar V, Saadat S, Rasouli MR, et al. Prevalence of spinal cord injury in Tehran, Iran[J]. J Spinal Cord Med,2009,32:428-31.
[9]Ahoniemi E, Alaranta H, Hokkinen EM, et al. Incidence of traumatic spinal cord injuries in Finland over a 30-year period[J]. Spinal Cord,2008,46:781-4.
[10]Leal-Filho MB, Borges G, Almeida BR, et al. Spinal cord injury: epidemiological study of 386 cases with emphasis on those patients admitted more than four hours after the trauma[J]. Arq Neuropsiquiatr,2008,66:365-8.
[11]Karacan I, Koyuncu H, Pekel O, et al. Traumatic spinal cord injuries in Turkey:a nation-wide epidemiological study[J]. Spinal Cord, 2000,38:697-701.
[12]Fisher CG, Noonan VK, Dvorak MF. Changing face of spine trauma care in North America[J]. Spine (Phila Pa 1976),2006,31:S2-8; discussion S36.
[13]Jackson AB, Dijkers M, Devivo MJ, et al. A demographic profile of new traumatic spinal cord injuries:change and stability over 30 years[J]. Arch Phys Med Rehabil,2004,85:1740-8.
[14]李建军,周红俊,洪毅,等.2002年北京市脊髓损伤发病率调查[J].中国康复理论与实践,2004,10：412-413.
[15]Vitale MG, Goss JM, Matsumoto H, et al. Epidemiology of pediatric spinal cord injury in the United States:years 1997 and 2000[J]. J Pediatr Orthop, 2006,26:745-9.
[16]Couris CM, Guilcher SJ, Munce SE, et al. Characteristics of adults with incident traumatic spinal cord injury in Ontario, Canada[J]. Spinal Cord, 2010,48:39-44.
[17]Brotherton SS, Krause JS, Nietert PJ. Falls in individuals with incomplete spinal cord injury [J]. Spinal Cord,2007,45:37-40.
[18]DeVivo MJ, Vogel LC. Epidemiology of spinal cord injury in children and adolescents[J]. J Spinal Cord Med,2004,27 Suppl 1:S4-10.
[19]Chiu WT, Lin HC, Lam C, et al. Review paper:epidemiology of traumatic spinal cord injury:comparisons between developed and developing countries[J]. Asia Pac J Public Health,2010,22:9-18.
[20]Tewari MK, Gifti DS, Singh P, et al. Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging:analysis of 40 patients[J]. Surg Neurol,2005,63:204-9; discussion 209.
[21]Kato H, Kimura A, Sasaki R, et al. Cervical spinal cord injury without bony injury:a multicenter retrospective study of emergency and critical care centers in Japan[J]. J Trauma,2008,65:373-9.
[22]郝春霞,李建军,周红俊,等.1264例住院脊髓损伤患者的流行病学分析[J].中国康复理论与实践,2007：1011-1013.
[23]Okada E, Matsumoto M, Ichihara D, et al. Aging of the cervical spine in healthy volunteers:a 10-year longitudinal magnetic resonance imaging study[J]. Spine (Phila Pa 1976),2009,34:706-12.
[24]Fassett DR, Harrop JS, Maltenfort M, et al. Mortality rates in geriatric patients with spinal cord injuries[J]. J Neurosurg Spine,2007,7:277-81.
[25]McKinley W, Santos K, Meade M, et al. Incidence and outcomes of spinal cord injury clinical syndromes[J]. J Spinal Cord Med,2007,30:215-24.
[26]Chapman JR, Agel J, Jurkovich GJ, et al. Thoracolumbar flexion-distraction injuries:associated morbidity and neurological outcomes [J]. Spine (Phila Pa 1976),2008,33:648-57.
[27]Macciocchi S, Seel RT, Thompson N, et al. Spinal cord injury and co-occurring traumatic brain injury:assessment and incidence[J]. Arch Phys Med Rehabil,2008,89:1350-7.
[28]Burney RE, Maio RF, Maynard F, et al. Incidence, characteristics, and outcome of spinal cord injury at trauma centers in North America[J]. Arch Surg,1993,128:596-9.
[29]Rosso A, Brazinova A, Janciak I, et al. Severe traumatic brain injury in Austria II:epidemiology of hospital admissions[J]. Wien Klin Wochenschr, 2007,119:29-34.
[30]Crane DA, Jaffee KM, Kundu A. Intractable pruritus after traumatic spinal cord injury[J]. J Spinal Cord Med,2009,32:436-9.
[31]Yezierski RP. Spinal cord injury pain:spinal and supraspinal mechanisms [J]. J Rehabil Res Dev,2009,46:95-107.
[32]Drigotaite N, Krisciunas A. [Complications after spinal cord injuries and their influence on the effectiveness of rehabilitation][J]. Medicina (Kaunas), 2006,42:877-80.
[33]McKinley W, McNamee S, Meade M, et al. Incidence, etiology, and risk factors for fever following acute spinal cord injury[J]. J Spinal Cord Med, 2006,29:501-6.
[34]Waddimba AC, Jain NB, Stolzmann K, et al. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury[J]. Arch Phys Med Rehabil, 2009,90:193-200.
[35]3rd CSC, Otis SM. Occurrence of fever associated with thermoregulatory dysfunction after acute traumatic spinal cord injury[J]. Am J Phys Med Rehabil,1995,74:114-9.
[36]Tauqir SF, Mirza S, Gul S, et al. Complications in patients with spinal cord injuries sustained in an earthquake in Northern Pakistan[J]. J Spinal Cord Med, 2007,30:373-7.
[37]Andrade MJ, Trepa A, Castro A, et al. [Urinary tract infections characterization in a spinal cord injury rehabilitation unit][J]. Acta Med Port, 2009,22:215-22.
[38]康辉,贾连顺,张亮,等.颈椎脊髓损伤患者并发低钠血症的相关因素分析[J].中国骨与关节损伤杂志,2008,23：1-3.
[39]Sica DA, Culpepper RM. Severe hyponatremia in spinal cord injury [J]. Am J Med Sci,1989,298:331-3.
[40]Krenz NR, Weaver LC. Changes in the morphology of sympathetic preganglionic neurons parallel the development of autonomic dysreflexia after spinal cord injury in rats[J]. Neurosci Lett,1998,243:61-4.
[41]Sugimoto Y, Ito Y, Tomioka M, et al. Deep venous thrombosis in patients with acute cervical spinal cord injury in a Japanese population:assessment with Doppler ultrasonography[J]. J Orthop Sci,2009,14:374-6.
[42]Aito S, Pieri A, D'Andrea M, et al. Primary prevention of deep venous thrombosis and pulmonary embolism in acute spinal cord injured patients[J]. Spinal Cord,2002,40:300-3.
[43]Ronen J, Itzkovich M, Bluvshtein V, et al. Length of stay in hospital following spinal cord lesions in Israel[J]. Spinal Cord,2004,42:353-8.
[44]董清,郭元吉.脊髓损伤住院病人的医疗和非医疗费用调查分析[J].中国医院统计,2004：120-122.
[45]Winslow C, Bode RK, Felton D, et al. Impact of respiratory complications on length of stay and hospital costs in acute cervical spine injury[J]. Chest, 2002,121:1548-54.
[46]McKinley W, Meade MA, Kirshblum S, et al. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury[J]. Arch Phys Med Rehabil,2004,85:1818-25.
[47]Ackery A, Tator C, Krassioukov A. A global perspective on spinal cord injury epidemiology [J]. J Neurotrauma,2004,21:1355-70.
[48]Fisher CG, Noonan VK, Smith DE, et al. Motor recovery, functional status, and health-related quality of life in patients with complete spinal cord injuries[J]. Spine (Phila Pa 1976),2005,30:2200-7.
[49]Ishida Y, Tominaga T. Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment[J]. Spine (Phila Pa 1976),2002,27:1652-8; discussion 1658.
[50]Miyanji F, Furlan JC, Aarabi B, et al. Acute cervical traumatic spinal cord injury:MR imaging findings correlated with neurologic outcome--prospective study with 100 consecutive patients[J]. Radiology,2007,243:820-7.
[51]Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia[J]. Spine (Phila Pa 1976), 2003,28:33-9.
[52]Andrade MJ, Goncalves S. [Traumatic spinal cord injury:neurologic and functional recovery][J]. Acta Med Port,2007,20:401-6.
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