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首页> 外文期刊>Journal of neurotrauma >Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery
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Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery

机译：颈脊髓损伤后的早期减压：检查从事故现场到手术的护理过程

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Early decompression may improve neurological outcome after spinal cord injury (SCI), but is often difficult to achieve because of logistical issues. The aims of this study were to 1) determine the time to decompression in cases of isolated cervical SCI in Australia and New Zealand and 2) determine where substantial delays occur as patients move from the accident scene to surgery. Data were extracted from medical records of patients aged 15-70 years with C3-T1 traumatic SCI between 2010 and 2013. A total of 192 patients were included. The median time from accident scene to decompression was 21 h, with the fastest times associated with closed reduction (6 h). A significant decrease in the time to decompression occurred from 2010 (31 h) to 2013 (19 h, p = 0.008). Patients undergoing direct surgical hospital admission had a significantly lower time to decompression, compared with patients undergoing pre-surgical hospital admission (12h vs. 26h, p < 0.0001). Medical stabilization and radiological investigation appeared not to influence the timing of surgery. The time taken to organize the operating theater following surgical hospital admission was a further factor delaying decompression (12.5 h). There was a relationship between the timing of decompression and the proportion of patients demonstrating substantial recovery (2-3 American Spinal Injury Association Impairment Scale grades). In conclusion, the time of cervical spine decompression markedly improved over the study period. Neurological recovery appeared to be promoted by rapid decompression. Direct surgical hospital admission, rapid organization of theater, and where possible, use of closed reduction, are likely to be effective strategies to reduce the time to decompression.
机译：早期减压可能会改善脊髓损伤（SCI）后的神经系统结局，但由于后勤问题，通常难以达到目的。这项研究的目的是：1）确定澳大利亚和新西兰孤立的颈椎脊髓损伤患者的减压时间，以及2）确定患者从事故现场转移到手术时发生明显延迟的位置。数据摘自2010年至2013年间C3-T1创伤性SCI年龄在15-70岁的患者的病历。共纳入192例患者。从事故现场到减压的中位时间为21小时，其中最快的时间与闭合复位（6小时）有关。从2010年（31小时）到2013年（19小时，p = 0.008），减压时间显着减少。与接受手术前住院的患者相比，直接接受手术入院的患者减压时间明显缩短（12h vs. 26h，p <0.0001）。医学稳定和放射学检查似乎不影响手术时间。手术入院后组织手术室所花费的时间是延迟减压（12.5小时）的另一个因素。减压时机与表明实质性康复的患者比例之间存在相关性（美国脊髓损伤协会2-3级损伤量表等级）。总之，在研究期间，颈椎减压时间明显缩短。快速减压可促进神经系统恢复。直接外科手术入院，迅速组织手术室以及在可能的情况下采用封闭复位术可能是减少减压时间的有效策略。

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