1、脊髓損傷 臨床上的問題 Spinal Cord Injury The Clinical Problem,Keith DK Luk Chair Professor & Head Dept of Orthopedics & Traumatology University of Hong Kong,Anatomy 解剖學,脊髓 中樞神經系統 Spinal cord (central nervous system)vs 馬尾叢 周邊神經系統 Cauda equina (peripheral nervous system),C1 to L1,L2 to S4,脊髓損傷的發病率 Incidence of
2、Spinal Cord Injury,在美國，每百萬人口約有40宗新病例 (每年10,000宗病例)40 new cases / million population in USA (about 10,000 cases per year)在歐洲, 台灣及香港，每百萬人口約有20宗新病例20 new cases / million population in Europe, Taiwan & Hong Kong National Spinal Injury Statistical Center, USA. 2004 http:/www.spinalcord.uab.edu,一九九八至九九年度
3、衛生署年報 Department of Health Annual Report 1998/99,脊髓損傷 365 病人 Spinal Cord Injury 365 patients,2000年衛生署資料 Department of Health Website Information,脊髓及神經受損 452 病人 Injury to nerves and spinal cord 452 patients,嚴重脊髓損傷 More Severe SCI,二零零四年上半年 共有71個病例First 6 months/2004 71 cases,常見脊髓損傷的原因 Common causes of
4、 spinal cord injury,交通意外 Motor vehicular accident 高處墜下Fall from height 運動創傷Sports & recreational injuries 暴力Violence,香港常見導致脊髓受損的原因 Common Causes of Spinal Cord Impairment in Hong Kong,退化病Degenerative diseases創傷Traumatic injuries腫瘤性疾病Neoplastic diseases發炎性疾病Inflammatory diseases,殘疾的程度 Disability rela
5、tes to:,受損水平Level of injury四肢癱瘓 Quadriplegia下肢癱瘓 Paraplegia,受損程度Degree of injury部份受損 Incomplete完全受損 Complete,高位脊髓受損 High Spinal Cord Injury,依賴呼吸機Ventilator dependent呼吸併發症Respiratory complication完全依賴Totally dependent,臨床問題 Clinical Problems,生理問題Physical心理問題 病人, 家屬Psychological Patient, Family社交問題 就業,
6、參與社會活動Socio-economical Employment, Community access,生理問題 Physical Problems,喪失活動能力Loss of motion失去感覺 Loss of sensation- Pressure ulcers褥瘡 痛楚Pain,生理問題 Physical Problems,交感神經功能Autonomic dysreflexia - 膀胱 尿滯留或小便失禁Bladder retention or incontinence- 大腸 便秘或失禁Bowel constipation or incontinence- 功能性障礙 Sexual
7、dysfunction痙攣 Spasticity,完全癱瘓者: 一年內: 約5-10%的病人約有兩節段的改善 90% 的病人有一節段的改善 少於1%的病人有兩節段以上的改善:For complete SCI: In one year: 90% of SCI patients improve one level. 5-10% of SCI patients improve two levels. less than 1% of SCI patients improve more than two levels半癱瘓者:比較難估計, 不過整體比完全癱瘓者優勝 For incomplete SCIl
8、ess predictable, tends to be better than complete injuriesNSCISC, 2004. http:/www.spinalcord.uab.edu,Natural history,傳統的療法 Conventional management,脊髓是不能被修補或再生Repair, regeneration of the spinal cord is not possible集中復康治療 主流治療方向 增強殘餘功能 恢復功能 減低傷殘Focus on rehabilitation Main stream management Maximize r
9、esidual functions Functional restoration Minimize disabilities,截癱性步行 Paraplegic walking,半癱瘓 Incomplete Paraplegia,家居改善 Home modification,公共交通工具 Transportation,香港現有的服務 Current Services in Hong Kong,幾乎所有的脊髓復康服務均由醫院管理局提供Nearly all spinal cord rehabilitation are provided by HA三間由醫管局提供的脊髓復康醫院3 SCI units under the Hospital Authority 香港區：麥理浩復康院, MacLehose Rehabilitation Centre 九龍區：九龍醫院, Kowloon Hospital 新界區：大埔醫院, Tai Po Hospital高技術水準的設備- FES, 矯具等 State-of- the-art facilities FES, orthosis, etc,脊髓損傷的治療及再生的可能 Potential for spinal cord repair and regeneration,再生療法 Regenerative therapies,
