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Epidemiology of Cervical Spinal Cord Injury in Tianjin

Author: JiaoXinXu
Tutor: FengShiQing
School: Tianjin Medical University
Course: Surgery
Keywords: Cervical spinal cord injury Complications Early death Risk factors Epidemiology
CLC: R651.2
Type: Master's thesis
Year: 2011
Downloads: 44
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Abstract


Objective To explore the epidemiological characteristics of traumatic cervical spinal cord injury (TCSCI) in Tianjin.Methods Clinical data of patients with TCSCI during January 2004~December 2008 in fourteen hospitals of Tianjin were analyzed retrospectively. Clinical data included patient’s age, gender, occupation, length of hospitalization, etiology, injuried level and severity, complications and treatment.Results1. Demographics 553 patients with cervical spinal cord injury (CSCI) accounted for 61.8% of 895 patients with spinal cord injury (SCI). The male (480 cases)-female (73 cases) ratio was 6.6:1. Mean age at CSCI was 48.02 years (range 11-90).Worker (176 cases,31.8%) and farmer (149 cases,26.9%) was main injuried group. The mean length of hospitalization was 23.16 days.2. Etiology The most common causes of TCSCI were MVA (n=208,37.6%) followed by minor falls (n=199,36.0%). MVA were the most frequent causes of TCSCI in the young (≤29 year-old) and middle-aged persons (30 to 49 year-old), producing 52.2% and 43.1% of CSCI, respectively. Falls from high heights (43.7%) and injury by heavy (47.5%) mainly distributed in between thirty and forty-nine years old. Minor falls were significantly more common in patients older than 50 years, accounting for 49.1% of TCSCI cases as compared to 29.8% for patients 50 years and younger.3. Injury and Treatment Cervical spinal cord injury without fracture or /and dislocation (CSCIWFD) was more common site of injury, accounting for 55.7% of CSCI (n=296). CSCIWFD was related to age of patients.C5 (n=224,40.5%) and C4 (n=163,29.5%) were the most common segments of injury. ASIA D (n=201) was the most frequent grade observed in the study, accounting for 36.3%. Incomplete injury (n=427) was more common than complete injury (n=126). Univariate analysis showed that severity of neurological deficits was related to age of patients (P=0.041). 279 patients with CSCI accepted conservative treatment. Of those patients,165 patients were submitted to the hospital within the eight hours after injury. As best we could determine, it appeared that 68.5% of patients had received treatment with methylprednisolone according to National Acute Spinal Cord Injury Studies NASCIS-Ⅱ. Surgical treatment was chosen for 49.5% of patients with CSCI.4. Complications 156 patients (28.2%) occured complications, as follows: respiratory (n=54,34.6%), cardiovascular (n=37,23.7%), electrolyte disturbance (n=28,17.9%) and urinary complications (n=21,13.5%). Univariate analysis showed that complications were related to age of patients (p=0.036)、surgery or not (P=0.000)、severity of neurological deficits (P=0.000)5. Early death The early mortality of patients with TCSCI was 3.98%(22/553). The common reason of early death was respiratory failure in 9 cases (40.9%) and electrolyte disorders in 5 cases (22.7%). Univariate analysis showed:age at injury, severity of cervical spinal cord injury, respiratory, cardiovascular or digestive and electrolyte disturbance complications, tracheotomy were considered statistically significant for early mortality in patients with TCSCI (P<0.05). Multivariate logistic regression analysis showed:age at injury (OR:3.831 P=0.025), degree of CSCI (OR:3.567; p=0.043), respiratory (OR:6.342; P=0.003) or cardiovascular (OR:23.383; P=0.000) and electrolyte disturbance complications (OR:6.817; p=0.003), tracheotomy or not (OR:10.075; P=0.003) were positively related to early mortality in patients with TCSCI.Conclusion1. TCSCI was more common of spinal cord injury (SCI), age of patients was much older.2. The leading cause of different age group was different.3. Cervical spinal cord injuriy without fracture and dislocation (CSCIWFD) mainly occurred in older groups.4. Patients with high ages or severity of neurological deficits were easy to occur comlplications.5. High age, severe CSCI, complications were risk factors for early mortality in patients with TCSCI.

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CLC: > Medicine, health > Surgery > Of surgery > Head and Neurosurgery > Spinal cord
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