小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 运动无力
- 精细运动协调能力丧失
- 痉挛状态
- 感觉异常、麻木、感觉不良
- 反射亢进和踝阵挛
- 病理反射
- 挛缩
- 肛周感觉、自主肛门挛缩和肛门张力丧失
- 自主神经反射障碍
- 脊髓空洞
其他诊断因素
- 中枢(中线)疼痛
- 束带样痛
- 肌肉骨骼或内脏疼痛
- 步态不稳
- 尿失禁或尿潴留
- 便秘
- 性功能障碍
- 非特异性不适感
- 神经根疼痛
危险因素
- 脊髓外伤或缺血
- 高节段脊髓损伤
- 两端年龄
- 椎管狭窄
- 男性
诊断性检查
需考虑的检查
- 脊柱 MRI 检查
- 肌电图 (EMG)
- 尿动力学研究
- 膀胱超声检查
- 肾脏超声
- 排泄性尿路造影
- 骨密度测定（DEXA）
- 实验室评估
治疗流程
进行性神经功能障碍
神经状态稳定
撰稿人
作者
Cristina Sadowsky, MD
Clinical Director
International Center for Spinal Cord Injury
Kennedy Krieger Institute
Associate Professor Physical Medicine and Rehabilitation
Johns Hopkins School of Medicine
Baltimore
MD
利益声明
CS has received grant reviews from the American Institute of Biological Sciences and Grand Rounds Sinai Hospital in Baltimore, and has consulted for General Dynamics Information Tech Inc. CS is an author of a number of references cited in this topic.
Travis Edmiston, MD
Assistant Professor for Physical Medicine and Rehabilitation
International Center for Spinal Cord Injury
Kennedy Krieger Institute
Baltimore
MD
利益声明
TE declares that he has no competing interests.
鸣谢
Dr Cristina Sadowsky and Dr Travis Edmiston would like to gratefully acknowledge Dr Kenneth Casey and Dr Jwalant Mehta, previous contributors to this topic.
利益声明
KC and JM declare that they have no competing interests.
同行评议者
Steven Kirshblum, MD
Medical Director and Director of Spinal Cord Injury Services
Kessler Institute for Rehabilitation
West Orange
Professor
University of Medicine and Dentistry of New Jersey/New Jersey Medical School
Newark
NJ
利益声明
SK declares that he has no competing interests.
Deborah Short, MRCP
Consultant in Rehabilitation Medicine
Robert Jones and Agnes Hunt Hospital
Oswestry
UK
利益声明
DS declares that she has no competing interests.
鉴别诊断
- 非压迫性脊髓病
- 压迫性脊髓病
更多 鉴别诊断指南
- 最佳临床实践指南：脊髓损伤
- 2022 年美国 CDC 临床实践指南：处方阿片类药物治疗疼痛
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