特殊类型的无骨折脱位型颈髓损伤治疗分析

为了探讨多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤的治疗,回顾了本院收治的4例多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤患者的临床资料,并结合相关文献报道进行分析。结果显示,4例患者均早期行前后路联合手术椎管减压,3例患者行预防性气管切开,4例患者术后随访时间6个月～48个月,平均随访24个月。固定节段均获骨性融合,内固定物无松动、断裂;后路手术无再关门现象。术后神经功能评价按Frankel分级,均有1个～2个级别恢复,术前A级2例,B级2例;术后B级2例,C级1例,D级1例。提示对于多节段后纵韧带骨化伴颈椎间盘突出的无骨折脱位型颈髓损伤早期行前后路联合手术减压;预防性气管切开可获得良好的治疗结果。     

Relationships Between Locus of Control, Coping Strategies and Emotional Well-Being in Persons with Spinal Cord Lesion

Relations between locus of control, coping strategies and emotional well-being in persons with traumatically acquired spinal cord lesion (SCL) were examined. The sample included 132 community-residing adults. Structural equation modelling, including confirmatory factor analysis, was used. A model was hypothesized based on the transactional theory of stress and coping where coping strategies mediated the relation between locus of control and emotional well-being. The model showed acceptable fit to the data and was compared with five alternative models. The alternative models fitted the data less well or were difficult to interpret. In the preferred model, persons indicating internal control reported more coping strategies (Acceptance, Fighting spirit) related to increased well-being, whereas persons indicating external control reported a coping strategy (Social reliance) related to poorer well-being. The findings support the stress and coping framework in medical rehabilitation and illustrate why some persons need coping effectiveness training to enhance emotional adjustment.     

对脊柱结核诊疗策略的思考

脊柱结核是临床常见病,其诊疗策略主要包括正确的诊断思路、合适的治疗选择。尤其重视非典型性脊柱结核的诊断,治疗方面要重视药物治疗、营养支持、休息制动等手段。对于需要手术治疗的患者,需个体化选择最适合的术式,且应完整理解并客观评估新技术的应用。     

脐血干细胞移植中的伦理思考

现代干细胞移植技术飞速发展。脐血干细胞移植在伦理学上具有胚胎干细胞和骨髓干细胞移植治疗不可比拟的优势,但是其伦理学上的可接受性并不等于伦理问题的消失。在脐血干细胞移植研究过程中,应该遵循伦理道德观和科学理性的原则,健康发展,造福人类。     

经验医学与腰椎间盘突出症的认知史

众所周知,腰椎间盘突出症是一种脊柱退变性疾病。本病的发现历史只有70多年,但它的存在历史却至少有几千年了。本文从有记载开始的古代文明回顾了腰椎间盘突出症的存在和发现过程,特别强调经验医学在疾病认知过程中的重要作用。本文还重点提出当代保守治疗和手术治疗的进展和原则变化情况。另外,根据最近的临床研究,本文认为,脊柱力学平衡在保守治疗过程中应该引起足够的临床重视。     

脊柱结核个体化综合治疗的思考

近年来脊柱结核迅速增多,严重威胁着人类的健康。本文分析目前脊柱结核治疗中存在的问题,围绕这些问题,从脊柱结核的化疗、手术、围手术期处理、术后督导治疗方面综合思考个体化综合治疗在脊柱结核中的应用。通过这些分析和思考,以期引导我们用系统全面的观点治疗脊柱结核,并最终控制其流行。     

The phenomenology of agency and intention in the face of paralysis and insentience

Studies of perception have focussed on sensation, though more recently the perception of action has, once more, become the subject of investigation. These studies have looked at acute experimental situations. The present paper discusses the subjective experience of those with either clinical syndromes of loss of movement or sensation (spinal cord injury, sensory neuronopathy syndrome or motor stroke), or with experimental paralysis or sensory loss. The differing phenomenology of these is explored and their effects on intention and agency discussed. It is shown that sensory loss can have effects on the focussing of motor command and that for some a sense of agency can return despite paralysis.

Early Versus Late Onset of Spinal Cord Injury Among the Elderly

The objective of this study is to compare elderly individuals with late (60 years old) versus early (<60 years old) onset spinal cord injury (SCI) across quality of life (QOL) domains for which cross-sectional design was used. The outcome measures selected were secondary medical complications (e.g., pneumonia, autonomic dysreflexia, number of days hospitalized), Functional Independence Measure (FIM), Satisfaction With Life Scale (SWLS), and the Craig Handicap Assessment and Reporting Technique (CHART). Analyses between groups showed that individuals with SCI onset 60 years of age or older were significantly older, had a greater proportion of incomplete lesions, were more likely to have SCI resulting from medical complication, and were less likely to be working. After controlling for differences in demographic and lesion characteristics, the majority of QOL domains were similar between groups. However, overall self-reported handicap (CHART-total score) was significantly greater among elderly with late onset SCI, particularly in the areas of physical independence and social integration. Differences in QOL between elderly with late versus early onset SCI were most prominent in the area of physical independence and social integration. The importance of appropriate statistical control, theoretical implications, and future directions are discussed.     

Social Problem-Solving Abilities and Health Behaviors Among Persons with Recent-Onset Spinal Cord Injury

Although many persons with spinal cord injuries (SCI) are at risk for preventable complications, very little research has examined the health behaviors of these individuals. In this study, we examined self-reported health behaviors of persons with recent-onset SCI. We also studied the association between health behaviors and social problem-solving abilities. The results indicated that positive problem-solving characteristics were associated with more adaptive wellness and accident prevention behaviors. A negative orientation toward problem solving and avoidant and impulsive/careless styles was associated with increased traffic and substance risk taking. Implications are discussed in terms of health education, research, and prevention programs.