花蓮地區脊髓損傷之調查及防治對策

Traumatic Spinal Cord Injuries in Hualien County

藍青(Ching Lan) ； 賴金鑫(Jin-Shin Lai) ； 張光華(Kwang-Hwa Chang) ； 簡毓瑾(Yuh-Chin Jean) ； 連倚南(I-Nan Lien)

《中華民國復健醫學會雜誌》 20期 (1992/12) Pp. 33-38

摘要

本研究之目的有四：(1)探討花蓮地區外傷性脊髓損傷（traumatic spinal cord injuries，以下簡稱SCI）的流行病學特徵；(2)瞭解該地區SCI患者的復健概況；(3)作為評估台灣鄉村地區SCI患者醫療需求之參考；(4)提出防治SCI的對策。本研究以病歷調閱之回溯方式，調查民國76年1月至79年12月間慈濟醫院、省立花蓮醫院、門諾醫院和陸軍805醫院等四所花蓮區域醫院所收治的SCI新病例。結果顯示當時花蓮地區有88名SCI新病例。如以該時期花運人口353,000人來計算，SCI的年發生率為 62.3 / 1,000,000，遠高於其他文獻的報告。在這88例患者中，四肢不完全麻痺者有32例；四肢完全麻痺者有29例；下半身不完全麻痺者有12例：而下半身完全麻痺者
有15例。其中男性有69例，女性有19例，男女性別比為3.6：1。男性患者受傷時的平均年齡為44±16歲，而女性為45±23歲。至於SCI的發生原因則以交通事故為首（佔60.2%），次為由高處跌落（佔23.9%）。患者平均住院日與神經障礙的型式有關：下半身不完全麻痺者最短（平均67±26日），而四肢完全麻痺者最長（平均135±72日）。患者最常見的併發症為神經性膀胱功能障礙（71例），次為壓瘡（19例）。88例中有10位患者在調查時已經死亡，死亡率為11.4%，主要死因為呼吸衰竭或敗血症。尚存活的78例中曾接受完整復健治療者有48例（62%），其餘則未治療或僅接受短期復健。可以獨立步行或使用輔具助行者有43例（55%），而日常生活完全獨立者有39例（50%）。本研究發現花蓮地區SCI的發生率偏高，且患者接受復健的比率偏低，其原因及防治對策將於文內一併討論。

關鍵字

spinal cord injury ； epidemiology ； rehabilitation

並列摘要

In order to survey the epidemiological characteristics and the overall rehabilitation profile of traumatic spinal cord injuries (SCI) in Hualien county, a retrospective study was conducted from January 1987 to December 1990 in four local general hospitals. During this period, 88 traumatic SCI patients were identified. The estimated annual incidence of traumatic SCI in Hualien county was 62.3 per million population. As a result of injury 32 patients were tetraparetic, 29 were tetraplegic, 12 were paraparetic and 15 were paraplegic. The male/female ratio was 3.6:1 The mean age of onset for male patients was 44 ± 16 years, and that for female patients was 45 ± 23 years. The major causes of SCI were traffic accident (60.2%), followed by accidentally fall (23.9%). The average duration of hospitalization ranged from 67 ± 26 days in paraparetics to 135 ± 72 days in tetraplegics. The most common complications were neurogenic bladder (88%), followed by pressure sore (22%). Ten patients died of respiratory failure or sepsis, and the mortality rate was 11.4%.
In the 78 patients who survived during this study, only 48 of them (62%) had received complete rehabilitation. Therefore, only 43 (55%) patients were ambulatory and 39 (55%) patients were independent in ADL. In addition, only 42 (59%) patients could attain self-voiding; the others failed to become catheter free.
In summary, our data revealed that Hualien county was a prevalent area of traumatic SCI in comparison with other studies. The major reason might be attributed to the preponderance of motorcycle as a transportation vehicle. In addition, our study also found that the rehabilitation attendance rate was relatively low in SCI patients. Therefore, we propose five strategies to enhance trauma prevention as well as patient management in this region: (1) implement the traffic regulations and popularize the concept of traffic safety, (2) execute the safety precautions of working place (3) manage the alcoholism properly, (4) integrate the medical resources and establish the emergency transfer system, (5) set up a SCI center for comprehensive medico-social management of the patients.