Objective To analyze the characteristics of 150 patients with spinal cord injury complicated with spasticity. Methods A cross-sectional survey was conducted on 150 patients with spinal cord injury accompanied by spasticity from September,2019 to December,2024.Their age,gender,cause of injury,injury site,severity of injury,spasticity severity and other indicators were recorded.The relationships between different characteristics were analyzed,and a correlation analysis of disease duration,spasticity grade,injury level,injury severity and age were conduct-ed. Results There was no significant difference in age distribution between patients with tetraplegia and paraplegia(Z=0.806,P=0.420).The proportions of trauma(χ2=3.982,P=0.046)and tetraplegia(χ2=10.559,P=0.010)were higher in males than in females.Trauma was the main cause of injury in both tetraplegia and paraplegia patients;the proportion of tetraplegia was higher than paraplegia in trauma patients,while paraplegia was higher than tetra-plegia in non-trauma patients(χ2=11.885,P<0.001).Patients with tetraplegia was dominated by incomplete in-jury,whereas patients with paraplegia was dominated by complete injury(χ2=10.885,P=0.012).Grade A injury was predominant in trauma patients(P=0.003).Spasticity grade showed a very weak positive correlation with disease duration(r=0.175,P=0.032)and age(r=0.168,P=0.040).Injury severity showed a very weak posi-tive correlation with age(r=0.183,P=0.025). Conclusion Characteristics of patients with spinal cord injury complicated with spasticity is different with gender,cause of injury,injury level,injury severity.

Objective To delineate imaging findings using an imaging platform and investigate the correlation between MRI charac-teristics of spinal cord atrophy and clinical diagnosis in children with spinal cord injury(SCI). Methods Imaging data of 150 children with SCI admitted to Beijing Bo'ai Hospital,China Rehabilitation Research Cen-ter,from January,2002 to March,2024 were collected and imported into the imaging platform.The anteroposteri-or and transverse diameters of the middle part of the spinal cord at the cross-section with the most severe atrophy were measured,and the relevant indicators of the previous normal spinal cord segment were measured as con-trols;the radiomic features were extracted.Clinical data of the children including gender,age,cause of injury,sensory level,motor level,spinal cord injury level,injury severity and disease course were collected. Results Spinal cord atrophy was identified in 81 cases(54%),among which 78 cases(96%)were American Spinal Inju-ry Association Impairment Scale(AIS)grade A and 3 cases(4%)were AIS grade C.The upper boundary of the spinal cord atrophy site strongly correlated with the injury level,motor level and sensory level(r>0.8,P<0.001). Conclusion More than half of children with SCI may develop secondary spinal cord atrophy,the vast majority of whom suffer from complete spinal cord injury;the upper boundary of spinal cord atrophy is correlated with the injury level.

案例 "我的丈夫是6年前车祸导致的颈5脊髓损伤,今年48岁,曾经在三甲医院住院进行康复治疗.我丈夫现在最大的困扰是大小便,尤其是大便问题.伤后第一年他使用开塞露后大便可排出,后来开塞露使用量越来越多,排便等待时间越来越长;最近半年多来,白天反复有严重的腹胀、腹痛,腹部CT检查提示结肠胀气,每天晚上需要灌肠后腹胀、腹痛才能缓解,第二天早上四五点又开始出现腹胀、腹痛,早餐后会突然加重,靠吃强效止痛药才能稍微减轻,最近灌肠后有时还会出现便血,另外每天灌肠会不会损伤肛门,这些情况该怎么办?"

目的 观察不完全性脊髓损伤患者步态对称性特点及影响因素.方法 2018年5月至2021年11月,北京博爱医院不完全性脊髓损伤患者34例,根据左右下肢运动评分的差异分为下肢对称损伤组(对称组,n = 15)和下肢非对称损伤组(非对称组,n = 19).采用三维运动采集系统和足底压力采集系统进行步态测试.计算步长以及站立相和迈步相对称值.结果 对称组的步长对称值、站立相对称值和迈步相对称值均明显低于非对称组(|t|＞2.619,P＜0.01).非对称组站立相对称值和迈步相对称值与双侧下肢肌力差值呈正相关(r＞0.468,P＜0.01).判别分析显示,下肢损伤不同对称性患者的步态参数方程不同.结论 下肢运动功能对称性影响脊髓损伤患者步态对称性,左右下肢运动总分的差值是重要的影响因素.步态参数可用于判定脊髓损伤患者的下肢损伤对称性.

CONTEXT:Patients with spinal cord injury (SCI) are at high risk for venous thromboembolism (VTE). The risk factors for VTE in patients with SCI are complex.OBJECTIVE:This meta-analysis was conducted to clarify the risk factors for VTE in patients with SCI.METHODS:The Cochrane Library, PubMed, EBSCO, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang Med Data Database, and VIP Database were searched to identify studies reporting on risk factors for VTE in patients with SCI.RESULTS:The meta-analysis included 25 studies. Findings showed that risk of VTE in patients with SCI was significantly associated with middle- and old-age (OR = 2.08, 95%CI, 1.47, 2.95), male sex (OR = 1.41, 95%CI, 1.26, 1.59), complete paralysis (OR = 3.69, 95%CI, 2.60, 5.24), personal/family history of venous thrombosis (OR = 1.95, 95%CI, 1.35, 2.81), history of smoking (OR = 2.67, 95%CI, 1.79, 3.98), lack of compression therapy (OR = 2.44, 95%CI, 1.59, 3.73), presence of lower limb/pelvic fracture (OR = 3.47, 95%CI, 1.79, 6.75), paraplegia (OR = 1.81, 95%CI, 1.49, 2.19), and diabetes (OR = 4.24, 95%CI, 2.75, 6.52).CONCLUSION:The meta-analysis identified 9 risk factors for VTE in patients with SCI. Healthcare providers should be aware of the risk factors for VTE when rehabilitating patients with SCI.

目的 探讨磁共振成像轴位T2加权像(T2WI)脑脊髓损伤中心(BASIC)评分评定创伤性颈脊髓损伤患者的价值.方法 回顾性分析2015年1月至2021年12月在北京博爱医院住院康复的创伤性颈脊髓损伤患者175例.统计患者的性别、年龄、受伤原因、损伤机制、AIS分级,对患者颈椎磁共振成像矢状位及轴位T2WI进行BASIC评分、单节段/多节段损伤、有/无髓内出血的影像学评估.按照损伤机制将患者分为骨折/骨折脱位型(n = 92)和无骨折脱位型(n = 83),比较两组人口学指标和磁共振成像T2WI评估指标,并探讨AIS分级与BASIC评分、有/无髓内出血、单节段/多节段损伤之间的关系.结果 两组性别、年龄和AIS分级均有非常高度显著性差异(t =-10.276,χ2＞12.570,P＜0.001),受伤原因无显著性差异(P＞0.05).两组间BASIC评分,髓内出血、单节段损伤发生率均有非常显著性差异(χ2＞8.703,P＜0.01).AIS分级与BASIC评分显著相关(r = 0.790,P＜0.001),有/无髓内出血、单节段/多节段损伤间的AIS分级有显著性差异(χ2＞5.516,P＜0.05).结论 磁共振成像T2WI的BASIC评分是创伤性颈脊髓损伤患者脊髓损伤严重程度的预测指标.不同损伤机制患者BASIC评分有差异.

目的 介绍伴并发症脊髓损伤的神经学分类新进展.方法 检索近10年国内外相关文献,总结相关内容.结果 2022年1月美国脊柱损伤协会(ASIA)国际标准委员会的专题小组发表的脊髓损伤神经学分类国际标准(ISNCSCI)提出伴并发症脊髓损伤的神经学分类新方法,应用扩展的"*"标记概念,可统一记录、评分和分类,对高于、位于或低于神经损伤平面受脊髓损伤并发症影响的感觉和运动检查结果.结论 伴并发症脊髓损伤的神经学分类新方法克服了既往ISNCSCI版本的不足,有助于提高ISNCSCI分类精确性,可供临床试用.

"我的女儿今年6岁,去年学舞蹈时因为下腰动作导致胸10完全性脊髓损伤,经过两家三甲医院的康复治疗后,现在能够自己翻身、坐起,能够坐轮椅活动,打算今年9月上小学.但孩子的下肢活动能力一直没有恢复,目前开始穿戴下肢长支具扶助行器进行步行训练;大小便也没有恢复,排尿依赖间歇导尿,排便依赖开塞露.去医院复查的时候看到一些脊髓损伤的孩子存在明显的脊柱侧弯和髋关节脱位,我很担心我的孩子也会出现这些并发症,请专家给出一些指导."

PURPOSE: Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI. METHODS: A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with ≥20 adolescents aged 13–17 years at least 6 months’ post rehabilitation. RESULTS: Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents’ plans for the future. CONCLUSION: Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.

目的 探讨脊髓损伤患者发病早期股骨远端及胫骨近端骨密度变化的规律.方法 选择2018年11月至2021年1月在北京博爱医院住院行康复治疗的脊髓损伤患者9例,测量入院时及入院6个月后股骨远端、胫骨近端、全髋和股骨颈骨密度.结果 与入院时相比,患者股骨远端、胫骨近端、全髋和股骨颈骨密度在入院6个月后均明显下降(∣Z∣>2.265,P<0.01).股骨颈的骨密度下降百分数与第2次测量时下肢运动评分呈负相关(r=-0.515,P=0.035).结论 脊髓损伤患者发病一年内股骨远端及胫骨近端骨密度明显下降.

目的 探讨脊髓损伤患者间歇导尿过程中自主神经反射障碍(AD)的发生情况及影响因素.方法 采用病例对照研究的方法 ,对2019年4月至2020年4月住院的脊髓损伤患者44例进行间歇导尿,收集年龄、性别、伤后时间、损伤节段、损伤程度、静息血压、导尿后即刻血压、导尿次数、导尿量、导尿操作持续时间等资料,对AD的发生情况和影响因素分别进行描述性分析及Logistic回归分析.结果 有26例(59.1％)出现AD.共导尿1738次,发生AD 187次(10.8％).随着伤后时间和年龄的增加,发生AD的风险增加(P<0.05);T7及以下脊髓损伤发生AD的风险明显低于T6及以上脊髓损伤(P=0.002).导尿次数、性别、损伤程度、导尿量和导尿操作持续时间不是发生AD的影响因素(P>0.05).结论 对SCI患者间歇导尿过程中AD的发生应有充分认识.对于T6及以上脊髓损伤、伤后时间长及老年患者,间歇导尿时建议常规监测血压,及时发现并处理AD.

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.

目的 探讨儿童下腰后脊髓损伤的临床表现及MRI特点.方法 对2002年1月1日至2020年8月31日北京博爱医院收治的下腰后脊髓损伤儿童的住院病历及MRI检查结果进行回顾性分析.结果 下腰后脊髓损伤儿童共120例,其中女童119例,男童1例;年龄38～162个月,中位数76个月;每年7月和9月发病人数较多(32例,26.7％),周末发病人数较多(67例,55.8％).临床主要表现为双下肢感觉运动障碍和大小便障碍(120例,100％).常见首发症状:突发腰疼(39例,32.5％)、下肢无力(30例,25.0％)和腿疼(10例,8.3％).症状达顶峰时间5 min～2 d,中位数50 min.104例下腰后脊髓损伤儿童1周内MRI特点:脊髓信号异常涉及下颈段及其以下的所有脊髓节段,信号异常的节段数量2～15个,中位数7个.常见信号异常节段为:T996例(92.3％)、T1096例(92.3％)、T1190例(86.5％).随访48例完全性脊髓损伤儿童MRI特点:伤后最早37 d即开始出现损伤节段以下至圆锥的广泛脊髓萎缩,随病程延长萎缩逐步加重,并可出现损伤节段以上的脊髓萎缩;随访31例不完全性SCI儿童的MRI,可见脊髓腰膨大局灶性脊髓信号异常,随病程延长出现脊髓腰膨大不同程度萎缩.所有病例均诊断为无骨折脱位型脊髓损伤,其中完全性胸段脊髓损伤89例(74.2％),不完全性胸、腰段脊髓损伤31例(25.8％).常见并发症:脊柱侧弯、髋关节发育异常、泌尿系感染、肾积水、骨质疏松、下肢病理性骨折和膝外翻.结论 下腰后儿童脊髓损伤临床主要表现为突发腰疼、双下肢感觉运动障碍和大小便障碍.大多数病例为胸段完全性脊髓损伤,MRI特点为早期出现以T9、T10为中心的多节段脊髓信号异常,晚期出现损伤节段以下至圆锥的广泛脊髓明显萎缩,可伴有损伤节段以上脊髓萎缩.

目的 观察脊髓损伤患者骨代谢标志物与临床特点的关系.方法 2018年7月至2019年12月,在本院住院康复治疗的脊髓损伤患者共135例,评定患者美国脊柱损伤协会残损分级(AIS),检测患者空腹血清β-I型胶原羧基端肽(β-CTX)、总I型前胶原N端前肽(TP1NP)、25-OH-维生素D[25(OH)D]、甲状旁腺激素(PTH)、血清钙和血清磷水平.分析性别、年龄、病程、AIS等临床特点与TP1NP、β-CTX、25(OH)D和PTH等骨代谢标志物的关系.结果 女性β-CTX和25(OH)D水平明显低于男性(|t|>2.044,P<0.01).不同年龄组间25(OH)D水平有显著性差异(F=3.156,P<0.05).所有患者β-CTX和TP1NP水平在脊髓损伤后4个月内逐渐升高,4个月后开始下降;PTH在脊髓损伤后4个月内逐渐下降,4个月后开始升高(P<0.001).AIS D级患者β-CTX水平低于A级和C级患者(t>2.679,P<0.05).截瘫患者TP1NP水平高于四肢瘫患者(Z=-2.035,P<0.05).有脊柱骨折或涉及脊柱手术的患者β-CTX水平高于无脊柱骨折或涉及脊柱手术的患者(t=2.169,P<0.05);下肢有运动功能的患者与下肢无运动功能的患者骨代谢标志物无显著性差异(t<0.839,Z<1.822,P>0.05).所有患者中25(OH)D缺乏和不足的比例占85.19％.结论 脊髓损伤后4个月内骨转换活跃,4个月后骨转换活跃程度逐渐下降,可能与损伤时有脊柱骨折或损伤后有涉及脊柱的手术有关.脊髓损伤对骨代谢标志物的影响尚不能明确.脊髓损伤患者普遍存在25(OH)D不足或缺乏.

Study design International multicentre cross-sectional study. Objectives To describe the organisation and systems of paediatric spinal cord injury (SCI) rehabilitation services in seven countries and compare them with available recommendations and key features of paediatric SCI. Setting Ten SCI rehabilitation units in seven countries admitting children and adolescents with SCI < 18 years of age. Methods An online survey reporting data from 2017. Descriptive and qualitative analysis were used to describe the data. Results The units reported large variations in catchment area, paediatric population and referrals, but similar challenges in discharge policy. Nine of the units were publicly funded. Three units had a paediatric SCI unit. The most frequent causes of traumatic injury were motor vehicle accidents, falls, and sports accidents. Unlike the other units, the Chinese units reported acrobatic dancing as a major cause. Mean length of stay in primary rehabilitation ranged between 18 and 203 days. Seven units offered life-long follow-up. There was a notable variation in staffing between the units; some of the teams were not optimal regarding the interdisciplinary and multiprofessional nature of the field. Eight units followed acknowledged standards and recommendations for specialised paediatric SCI rehabilitation and focused on family-centred care and rehabilitation as a dynamic process adapting to the child and the family. Conclusions As anticipated, we found differences in the organisation and administration of rehabilitation services for paediatric SCI in the ten rehabilitation units in seven countries. This might indicate a need for internationally approved, evidence-based guidelines for specialised paediatric SCI rehabilitation.

目的 调查脊髓损伤儿童神经功能预后及并发症的发生特点.方法 选取2011年至2019年收治的15岁以下脊髓损伤儿童,记录损伤后1个月、3个月和1年的脊髓损伤神经学平面、美国脊柱损伤协会残损分级(AIS),并对压疮/烫伤、泌尿系感染、肾积水/膀胱输尿管返流、便秘、骨质疏松/骨折、深静脉血栓、神经痛、异位骨化、脊柱侧弯和髋关节发育不良等儿童脊髓损伤常见并发症的发生情况进行全面调查.结果 159例脊髓损伤儿童中,男性41例,女性118例;受伤年龄2～14岁,平均(6.08±2.57)岁;主要致伤原因为运动损伤(47.8％);主要损伤部位为胸段脊髓损伤(81.1％).脊髓损伤儿童的致伤原因与损伤年龄(r=-0.160,P=0.044)、性别(r=-0.458,P<0.001)和脊髓损伤部位(r=-0.249,P=0.002)相关.71.7％为完全性脊髓损伤,损伤1个月与损伤12个月的AIS显著相关(r=0.984,P<0.001).主要并发症为泌尿系感染(69.2％)、便秘(67.9％)、肾积水/膀胱输尿管返流(37.7％)、脊柱侧弯(25.8％)、髋关节发育不良(25.2％).压疮/烫伤与脊髓损伤部位相关(r=0.179,P=0.024).损伤3个月脊髓损伤儿童的AIS与泌尿系感染、便秘、脊柱侧弯、髋关节发育不良明显相关(|r|>0.227,P<0.01).压疮/烫伤与骨质疏松/骨折的发生明显相关(r=0.208,P<0.01).泌尿系感染的发生与肾积水/膀胱输尿管返流、便秘、脊柱侧弯、髋关节发育不良显著相关(r>0.261,P<0.001),与骨质疏松/骨折的发生相关(r=0.195,P<0.05).肾积水/膀胱输尿管返流的发生与便秘、骨质疏松/骨折、脊柱侧弯和髋关节发育不良明显相关(r>0.146,P<0.01).便秘的发生与脊柱侧弯、髋关节发育不良显著相关(r>0.313,P<0.01),与骨质疏松/骨折的发生相关(r=0.160,P<0.05).骨质疏松/骨折的发生与脊柱侧弯、髋关节发育不良显著相关(r>0.342,P<0.01).脊柱侧弯与髋关节发育不良明显相关(r=0.818,P<0.001).结论 儿童脊髓损伤后神经功能恢复与AIS密切相关,完全性脊髓损伤患者预后不良.儿童脊髓损伤后常见并发症具有特定的年龄特征,泌尿系感染、便秘、肾积水/膀胱输尿管返流、脊柱侧弯、髋关节发育不良为常见并发症,需要高度重视.

目的 探讨儿童脊髓损伤致伤原因变化特点与预防策略.方法 对2015年1月1日至2019年12月31日本院收治的14岁以下脊髓损伤患儿进行致伤原因和人口学特点的回顾性分析.结果 脊髓损伤患儿共221例,其中男童62例,女童159例;在1～13岁各年龄段均有分布,中位数6岁;4～7岁患儿最多(55.7％),以女童为主(83.7％).儿童脊髓损伤的前5位致伤原因分别是体育运动损伤78例(35.3％)、非外伤性损伤56例(25.3％)、其他外伤48例(21.7％)、交通事故24例(10.9％)和高处坠落12例(5.4％).在体育运动损伤病例中,下腰动作导致的脊髓损伤75例(96.2％),主要发生在5～7岁(80.0％),均为无骨折脱位型胸脊髓损伤,其中完全性脊髓损伤53例(70.7％).结论 近年来儿童因练习舞蹈下腰动作导致的脊髓损伤增多,应重视下腰训练前的专业评估和风险教育,积极采取防范措施.

目的 检验数字评分法在脊髓损伤感觉异常关键点评分中的重测信度和评测者间信度.方法 2016年10月至2018年10月,采用数字评分法对69例脊髓损伤患者的感觉异常关键点进行评分.评测者A对关键点进行第一次评分,次日评测者B对同一关键点进行再次评分.3周后由评测者A再次对同一患者进行评分.结果 两侧肢体针刺觉评分和轻触觉评分的重测信度(r>0.88,P<0.001)和评测者间信度(ICC>0.93,P<0.001)均良好.颈段、胸段和腰段针刺觉评分和轻触觉评分的重测信度(r>0.88,P<0.001)和评测者间信度(ICC>0.93,P<0.001)均良好.结论 数字评分法在脊髓损伤患者感觉异常关键点评分中具有良好的重测信度和评测者间信度.

STUDY DESIGN:Psychometrics study.OBJECTIVE:The objective of this study was to introduce a novel tool for pinprick sensation examination and validate its usefulness in patients with spinal cord injury (SCI).SETTING:China Rehabilitation Research Center, Capital Medical University School of Rehabilitation Medicine, China.METHODS:A set of cone tools with different tapers (22.5°, 45°, 67.5°, 90°, 112.5°, 135°, 157.5°, and 180°) was made. The cone tool was validated first in 91 able-bodied individuals and then in 30 patients with SCI. The reliability and validity of the cone tool were analyzed by comparing the results of a pinprick sensation examination with the results of the International Standards for the Neurological Classification of SCI (ISNCSCI), the cone tool, and the thermal analyzer.RESULTS:The intraclass correlation coefficient (ICC) of the cone tool in able-bodied individuals was between 0.48 and 0.94 while that of the cone tool and the ISNCSCI tool ranged between 0.43 and 0.78. Pinprick sensation in patients with SCI can be graded into five levels using four tapers (22.5°, 45°, 67.5°, and 90°): normal, slight impairment, moderate impairment, severe impairment, and complete loss of sensation.CONCLUSION:This easy-to-use cone tool can produce a reliable semi-quantitative pinprick test result and is useful for pinprick sensation examination in patients with SCI.

目的 探讨2019版脊髓损伤神经学分类国际标准(ISNCSCI)检查表的修订之处及其意义.方法 通过逐字对比ASIA国际标准委员会提供的2019版ISNCSCI检查表(英文版)与2015版ISNCSCI检查表(英文版),找出修订之处,结合临床经验,分析并解读其修订意义.结果 与2015版相比,2019版共有5处改动.新版的检查表对运动、感觉评分及部分保留带(ZPP)的定义进行重大修订.结论 ASIA标准委员会根据应用2015版ISNCSCI检查表的实践体会,对该检查表进行较大的修订,提出更加科学的记录方法,使之能更加直观、清楚地反映检查结果.