脊髓损伤fankle评估ppt课件.pptVIP

脊髓损伤功能评估Evaluation of Spinal Cord Injury ;脊髓损伤spinal cord injury;一、截瘫指数法：; 一般记录肢体自主运动、感觉及两便的功能情况。相加后即为该病人的截瘫指数，如某病人自主运动完全丧失，而其他两项为部分丧失， 则该病人的截瘫指数为2＋1＋1＝4;Frankel 脊髓损伤分级法 ; 二、 Frankel法　 1969年由Frankel提出。其将损伤平面以下感觉和运动存留情况分为五个级别。 Frankel HL, Hancock DO, Hyslop G et al. The value of posturalreduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 1969; 7(3): 179-92 ;不完全性损伤 ( Incomplete injury )　　 如果在损伤神经平面以下[包括最低位的骶段(S4 - S5)]保留部分感觉或运动 ,则此损伤被定义为不完全性损伤。骶部感觉包括肛门粘膜皮肤交界处和肛门深部的感觉。骶部运动功能检查是通过肛门指检发现肛门外括约肌有无自主收缩。 Incomplete injury If partial preservation of sensory and/or motor functions is found below the neurological level and includes the lowest sacral segment, the injury is defined as incomplete. Sacral sensation includes sensation at the anal mucocutaneous junction as well as deep anal sensation. The test of motor function is the presence of voluntary contraction of the external anal sphincter upon digital examination.; Frankel 脊髓损伤分级法 A 完全 - 运动、感觉功能完全丧失 B 不完全 - 仅保留感觉 C 不完全 - 仅保留运动 (无功能) D 不完全 - 保留运动 (有功能) E 所有运动、感觉功能完全恢复， 但可能有异常反射 ;; Frankel法对脊髓损伤的程度进行了粗略的分级，对脊髓损伤的评定有较大的实用价值，但对脊髓圆椎和马尾损伤的评定有一定的缺陷，缺乏反射和括约肌功能判断，尤其是对膀胱、直肠括约肌功能状况表达不够清楚。; 1992年美国脊髓损伤学会（ American Spinal Injury Association， ASIA）用与Frankel标准类似的病损分级（Impairment Scale, IS）， 即修订的Frankel分级进行损伤分级： 美国脊髓损伤学会(ASIA)脊髓功能损害分级;美国脊髓损伤学会(ASIA)脊髓功能损害分级;Asia impairment scale (modified from Frankel) The following scale is used in grading the degree of impairment: A=Complete. No sensory or motor function is preserved in the sacral segments S4-S5 B=Incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5.;C=Incomplete. Motor function is preserved below the neurological level, and