• Zhonghua yi xue za zhi · Dec 2013

    Comparative Study

    [Value of preventive tracheotomy in patients with acute cervical spinal cord injury].

    • Hao-tian Wu, Chang-ping Zhao, Zhi Li, Jin-cheng Yan, Jian-dong Hao, and Zeng-yan Li.
    • Department of Orthopedic Surgery, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China. Email: surgeon_wu@126.com.
    • Zhonghua Yi Xue Za Zhi. 2013 Dec 17; 93 (47): 3762-5.

    ObjectiveTo evaluate the value of preventive tracheotomy in patients with acute cervical spinal cord injury.MethodsA retrospective analysis was performed on 54 cases of severe C4-C8 cervical spinal cord injury patients undergoing anterior fixation. They were classified as A and B according to the criteria of American Spinal Injury Association. And no tracheotomy was performed preoperatively. The patients with a high risk of dyspnea and with an indication for preventive tracheotomy received a preventive tracheotomy right after anterior fixation. 11 cases were classified into tracheotomy group and 43 cases were in non-tracheotomy group. The preoperative and hospital stays, incidence of hypoxemia and pulmonary infection, incidence of surgical incision site infection and mortality were analyzed between two groups.ResultsThe preoperative and hospital stays of tracheotomy group were shorter than those of non-tracheotomy group (2.9 ± 1.2 vs 5.7 ± 4.4 days, 10.3 ± 4.0 vs 16.5 ± 9.2 days). The incidence of hypoxemia was lower in tracheotomy group (9.1% vs 44.2%). There was difference existed between two groups. 44.2% patients in the non-tracheotomy group underwent tracheotomy or endotracheal intubation for dyspnea and hypoxemia. There was no significant difference between two groups in the incidence of pulmonary infection (9.1% vs 7.0%) or surgical incision site infection (0 vs 2.3%). The mortality of non-tracheotomy group was 3.07 folds of that of tracheotomy group (9.1% vs 27.9%). But there was no significant statistical difference.ConclusionThe preventive tracheotomy is an effective solution for the patients with respiratory compromises, a high risk of dyspnea and with an indication for preventive tracheotomy. The preventive tracheotomy for severe cervical spinal cord can improve respiratory function effectively and fixation may be performed earlier. And there are lower rates of mortality and infection.

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