2018年中国创伤性脊髓损伤流行病学特点

Epidemiological characteristics of traumatic spinal cord injury in China in 2018

目的统计和分析2018年中国创伤性脊髓损伤发病率的流行病学特点。方法采用多阶段分层整群抽样的方法,从我国3个区域、9个省、27个市随机抽取具有收治脊髓损伤患者能力的医院,回顾性调查2018年收治的符合条件的创伤性脊髓损伤患者。计算全国及各区域的发病率。通过病案调查表采集患者的一般资料、致伤原因、损伤水平、损伤程度、合并骨折节段和类型、合并伤、并发症、死亡情况等数据,并根据地理区域、年龄、性别进行分析。结果本研究纳入4 134例患者的医疗记录,其中男女比例为2.99∶1。中国2018 年创伤性脊髓损伤发病率为50. 484人次/100万人(95%CI 50.122~50.846)。东部地区的发病率最高为53. 791人次/100万人(95%CI 53.217~54.365)。主要致伤原因在全国为高处坠落伤(29.58%),西部地区同全国(40.68%),而东部地区和中部地区为交通伤(31.22%、30.10%)。主要损伤水平在全国为颈髓(64.49%),且中部地区颈髓损伤的比例最高(74.68%),西部地区腰骶髓损伤的比例最高(32.30%)。损伤程度发生率最高的为不完全性四肢瘫(55.20%),且在各个地区的分布规律一致。65.87%的患者合并骨折或脱位,其中西部地区合并比例高达77.95%,而中部地区合并比例仅54.77%。在全国,以头颈部为最主要合并伤(37.87%),东部、中部地区的合并伤分布规律同全国,而西部地区以胸部合并伤(38.57%)的比例最高。32.90%的患者并发呼吸系统并发症。23例(0.56%)患者院内死亡,其中17例(73.91%)因呼吸功能障碍死亡。结论我国创伤性脊髓损伤的高发病率地区是东部,主要致伤原因为高处坠落伤,以颈髓损伤为最主要损伤节段,以不完全性四肢瘫发生率最高,以头颈部损伤为最主要合并伤,以呼吸系统并发症为最主要并发症。

Objective To analyze the incidence and epidemiological characteristics of traumatic spinal cord injury in China in 2018.Methods Multi-stage stratified cluster sampling was used to randomly select hospitals capable of treating patients with spinal cord injury from 3 regions,9 provinces and 27 cities in China to retrospectively investigate eligible patients with traumatic spinal cord injury admitted in 2018.National and regional incidence rates were calculated.The data of cause of injury,injury level,severity of injury,segment and type of fracture,complications,death and other data were collected by medical record questionnaire,and analyzed according to geographical region,age and gender.Results Medical records of 4,134 patients were included in this study,with a male-to-female ratio of 2.99:1.The incidence of traumatic spinal cord injury in China in 2018 was 50.484/1 million(95%CI 50.122-50.846).The highest incidence in the Eastern region was 53.791/1 million(95%CI 53.217-54.365).In the whole country,the main causes of injury were high falls(29.58%),as well as in the Western region(40.68%),while the main causes of injury in the Eastern and Central regions were traffic injuries(31.22%,30.10%).The main injury level was cervical spinal cord in the whole country(64.49%),and the proportion of cervical spinal cord injury in the Central region was the highest(74.68%),and the proportion of lumbosacral spinal cord injury in the Western region was the highest(32.30%).The highest proportion of degree of injury was incomplete quadriplegia(55.20%),and the distribution pattern was the same in each region.A total of 65.87%of the patients were complicated with fracture or dislocation,77.95%in the Western region and only 54.77%in the Central region.In the whole country,the head was the main combined injury(37.87%),as well as in the Eastern and Central regions,while the proportion of chest combined injury in the Western region was the highest(38.57%).A total of 32.90%of the patients were complicated with respiratory complications.There were 23 patients(0.56%)died in hospital,of which 17(73.91%)died of respiratory dysfunction.Conclusions The Eastern region of China has a high incidence of traumatic spinal cord injury.Other epidemiological features include high fall as the main cause of injury cervical spinal cord injury as the main injury level,incomplete quadriplegia as the main degree of injury,head as the main combined injury,and respiratory complications as the main complication.