I. Definition of spinal cord injury (SCI)
It is the damage to the structure and function of the spinal cord caused by various reasons, resulting in the impairment of spinal cord nerve function (motor, sensory, sphincter and vegetative nerve function) below the plane of injury.
Second, the clinical manifestations
1.Tetraplegia: It refers to the damage to the cervical spinal cord, excluding the damage to the brachial plexus or peripheral nerves outside the spinal canal. The manifestation is different degrees of paralysis of the limbs and trunk and dysfunction of the second stool.
2.Paraplegia: refers to the injury of the thoracic, lumbar or sacral segments of the spinal cord within the spinal canal. The upper limbs function normally, but the injured segments are different, the trunk and lower limbs are paralyzed to different degrees, and the second stool is impaired.
Third, common complications.
1, pressure sores: the key is prevention, measures to.
1, regular changes of position, general lying position every 2 hours to turn over once.
2. Reduce the pressure on the protruding part of the bone, especially in the sitting position with special attention to decompression of the hip.
3, choose good cushions and mattresses.
4.Improve the nutritional status of the whole body.
5.Paying attention to skin care and maintaining skin hygiene.
6. Educate patients and their families about pressure sore prevention.
7. weight loss and weight control for those who are excessively obese
8. local insulation and massage.
Most likely site: paralyzed area, bony prominence.
Prevalent sites: sacrococcygeal, greater trochanter, sciatic tuberosity, heel, scapula, spinous process, posterior head; injuries above T4: posterior sciatic; during bed rest: sacrococcygeal; in wheelchair: sciatic tuberosity.
Hazards of pressure ulcers: hypoproteinemia and anemia, infection, pathological fracture when it affects bone tissue, deep pressure ulcers of the hip joint eroding blood vessels may cause hemorrhage and cancer.
2. Urinary tract complications
Urinary tract infection, urinary stones, spastic atrophic bladder, vesicoureteral reflux phenomenon (UVR), urethral fistula, urethral diverticulum.
Urological management measures.
1. early discontinuation of indwelling urinary catheters and introduction of intermittent (clean) catheterization.
2. apply appropriate voiding modalities and medications to maintain low-pressure bladder storage and low-pressure voiding according to urodynamic findings.
3.Regular examination of urological ultrasound, urinary routine, midstream urine culture, urodynamics.
4.Cultivate good personal hygiene habits and pay attention to keep the perineum clean.
5. oral stone prevention medications such as lithotripsy granules and alkalinization of urine can be taken.
6, antibiotics are not needed for long-term asymptomatic bacteriuria to avoid the risk of multiplying and infecting multiple drug-resistant bacteria.
3. Spasm treatment measures.
1.Discovery and removal of factors that contribute to worsening spasm, such as avoiding positions that cause muscle tension, controlling infection, stabilizing mood, and maintaining environmental temperature.
2, physical therapy: maintenance or expansion or improvement of joint mobility (ROM) training, standing (electric rising bed or standing frame) training, cold therapy, hydrotherapy, alternating electrical stimulation.
3. medications: baclofen (baclofen), diazepam (Valium), nitrofuranhydrin (dantrolene) dantrolene, ponderol (tizanidine) titonidine, myonol (myonol).
4, local nerve block: botulinum toxin injection, ethanol, phenol injection.
5.Posterior spinal cord rhizotomy.
4.Heterotopic ossification
Definition: It refers to the formation of bone within the soft tissue. It is mostly seen in hip, knee, elbow and shoulder joints, and the mechanism of occurrence is unclear.
Occurrence time: early in 3-4 weeks after the injury, late after 3.5 years, mostly in 1.5-2.5 months after the injury.
Symptoms: mostly local inflammation with swelling and redness, those with incomplete paralysis complain of local pain.
Diagnosis: clinical manifestations: redness and heat around large joints → swelling subsides → near joints → hard masses can be palpated → affect ROM → inconvenient movements such as sitting, transferring and dressing → easily lead to pressure sores.
Biochemical examination: ALP is elevated.
Imaging examination: after 1.5-2.5 months after the injury, it can be observed on X-ray film. X-rays can be used to observe the lesion passage. CT is good for early diagnosis; 99mTC bone scan is an important reference basis for the progress of ossification.
5.Deep vein thrombosis of lower extremity
Diagnosis: swelling and edema of the lower limbs are rapid, and they cannot disappear even when the lower limbs are elevated, and special attention should be paid when they appear on one side in particular. It is sometimes accompanied by cyanosis, local inflammation and fever, accelerated blood flow and leukocytosis.
Clinical examination: measurement of limb circumference and skin temperature; ultrasound: fast and accurate; venography: most accurate.
Isotope angiography.
Prophylaxis is started 48 hours after the injury.
1, mechanical prophylaxis: intravenous pumps, positive air pressure therapy, elastic stockings, etc.
2, drug prophylaxis: heparin, vitamin K antagonist, etc.
6.Upright hypotension (postural hypotension)
Performance: blood pressure drop, dizziness, nausea, cold sweat.
Causes: impaired vascular regulation mechanisms in the lower extremities: autonomic dysfunction, vasodilation, decreased muscle tone, increased venous compliance; decreased blood volume.
Treatment: vascular adaptation training, increase blood volume, increase muscle pressure: elastic stockings, abdominal girth; nutritional supplementation.
7, osteoporosis: diagnostic gold standard: dual-energy X-ray bone density test. Treatment with early interventions: passive standing training, functional electrical stimulation, pulsed electromagnetic field.
8, paraplegic neuralgia (pain): comprehensive measures: medication + physical therapy (myoelectric biofeedback or high-frequency electricity) + behavioral psychotherapy.
9, vegetative hyperreflexia: the most serious complication, more common in segmental injuries above T6.
Main triggers: bladder filling/infection, rectal dilatation (during examination), sexual intercourse, pressure sores, pain above the plane of injury, urinary/genital pain, catheterization, urinary tract infection, epididymitis, penile/testicular pressure, other injurious stimuli.
Clinical manifestations: acute/systemic/sudden/reflex, sympathetic hyperexcitation, facial flushing, skin sweating above the plane of injury, elevated blood pressure (40 mmHg higher than usual), bradycardia or tachycardia, pulsatile headache, nausea, sweating, bradycardia, hypertensive comorbidities (CVA, impaired consciousness, visual impairment, coma, seizures, hypertensive encephalopathy).
Importance of treatment: acute, correction of triggers in patients with spinal cord injury can provide immediate relief.
Treatment: bed position (elevated bed position or sitting up)
Identification of triggers: loosening of clothing and relaxation of other body-worn objects, examination of bladder, examination of rectum, defecation, examination of internal organs
Antihypertensive: sit, test blood pressure/heart rate, release after 2 hours of relief; calcium antagonists, vasodilators available for systolic blood pressure >150 mmHg
Maintenance: intravenous anti-hypertensives, bedside monitoring
10. Respiratory complications
Main cause of early death, with ventilation disorders, pulmonary atelectasis, pneumonia more common.
1.Pulmonary infection
Causes: reduced local defense and immune function of the respiratory tract; accumulation of respiratory sputum; in-hospital infection.
Prevention and treatment: strengthen turning and back patting, encourage coughing and sputum discharge, and remove airway secretions (postural drainage of sputum); use of antimicrobial agents is the same as for general lung infections.
2. Pulmonary atelectasis
Causes: lung inflammation; airway secretion retention.
Treatment: sputum aspiration, nebulization; expectoration and drugs to release bronchospasm; systemic application of antibiotics and correction of water-electrolyte imbalance. If conservative is ineffective, apply fibrinoscopy to relieve pulmonary atelectasis —- i.e. lung lavage.
11.Digestive system complications
1.Constipation
Prevention and treatment: develop regular defecation habits; defecation reflex training, let the patient sit to defecate, increase abdominal pressure, give appropriate stimulation or finger stimulation, such as pressing the anal part and lower abdomen; increase coarse fiber food; apply laxatives, enema, acupuncture, etc. if necessary.
2, peptic ulcer and paralytic intestinal obstruction.