Læknablaðið - 15.07.1998, Blaðsíða 19

LÆKNABLAÐIÐ 1998; 84
541
Faraldsfræði og fylgikvillar hjá
hjólastólabundnum mænusköðuðum
einstaklingum á íslandi
Óskar Ragnarsson’1, Guðmundur Geirsson21
Ragnarsson Ó, Geirsson G
Epidemiology and medical complications in pa-
tients with traumatic spinal cord injuries in Ice-
land
Læknablaðið 1998; 84: 541-51
Objective: To study the epidemiology of traumatic
spinal cord injuries in Iceland, that have caused
wheelchair-bound disability. To evaluate the fre-
quency of medical complications in this group of
patients both during the acute- and rehabilitation-
stage as well as after discharge. To study the present
condition and problems related to the urinary tract 1-
23 years after the injury.
Material and methods: Medical records of all
wheelchair-bound traumatic spinal cord injured
individuals in Iceland in 1973-1996 were reviewed
and the frequency of various medical complications
recorded. Long-term complications were assessed by
personal interviews. Urodynamic investigations were
performed and the present kidney morphology and
function studied by various radiological methods.
Results: The annual incidence of studied spinal cord
injuries was 8:1,000,000. During the acute- and
rehabilitation-stage the following complications
were encountered; 14 patients (29%) got pressure
sores, eight (17%) deep vein thrombosis, six (12%)
pneumonia and five (10%) pulmonary embolism. In
the follow-up after discharge and mean follow-up
time of 14 years, 19 (54%) have had pressure sores,
Frá "læknadeild Háskóla íslands, 21 þvagfæraskurðdeild
Sjúkrahúss Reykjavíkur. Fyrirspurnir, bréfaskipti: Guð-
mundur Geirsson, þvagfæraskurðdeild Sjúkrahúss
Reykjavíkur, sími: 525 1000.
Lykilorð: mænuskaðar, faraldsfræði, fylgikvillar, þvag-
færi.
16 (46%) have had one to four urinary tract infec-
tions each year, nine (26%) more than four. Nineteen
patients (56%) complained of urinary incontinance
and 18 (52%) had a history of urinary tract stones.
One patient had lost a kidney due to reflux. Patho-
logical findings were found in one third of patients
who came for upper urinary tract image studies.
Maximal detrusor pressure over 60 cml-LO was
recorded in 12 (44%) patients and bladder capacity
under 200 ml in seven (26%). Of those with injury
above Th-6, 14 (58%) had experienced symptoms of
autonomous dysreflexia, most commonly due to uri-
nary tract infection or distended urinary bladder.
Complications were more common among those who
use reflex-voiding rather than intermittent catheteri-
sation. One-third of the patients were either advised
to change their way of bladder emptying or required
pharmacological intervention according to results
from urinary tract investigations.
Conclusions: The incidence of traumatic spinal cord
injuries in Iceland, which have caused wheelchair-
bound disability, is low and has decreased over the
past 25 years. Acute and long-term medical compli-
cations are, however, common in these patients. A
more efficient follow-up program is needed to opti-
mize bladder treatment and to reduce urinary tract
and other medical complications in this patient popu-
lation.
Key words: spinal cord injuries, epidemioiogy, compli-
cations, urinary tract.
Ágrip
Tilgangur: Að kanna faraldsfræði mænu-
skaða á íslandi sem valdið hafa hjólastólabund-
inni lömun og meta tíðni ýmissa líkamlegra
fylgikvilla viðkomandi sjúklinga á bráða- og
endurhæfingarstigi og að endurhæfingu lok-
inni. Einnig að meta núverandi ástand þvag-
færa 1-23 árum eftir áverka.