Abstract：
Acute traumatic spinal cord injury (tSCI) is a complex and heterogeneous injury, where the level of injury, injury severity, duration and degree of spinal cord compression, and blood pressure management seem to influence neurologic outcome. Although data in the literature seem to be inconsistent regarding the effectiveness of surgical decompression and spinal fixation in patients with thoracic and thoracolumbar tSCI, some single-center studies suggest that early surgical decompression may lead to a superior neurologic outcome, especially in patients with incomplete tSCI, suggesting surgical decompression to be performed as soon as possible. However, high energy injuries, especially to the upper thoracic levels, may be too severe to be influenced by surgical decompression, which may represent a critical second hit for the polytraumatized patient. Therefore, the surgeon first needs to critically evaluate the potential for neurologic recovery in each patient before determining the ideal timing of surgery. Circulatory stabilization must be achieved before surgical intervention, and minimally invasive procedures should be preferred. Invasive blood pressure monitoring should be started on admission, and maintenance of a MAP between 85 and 90 mmHg is recommended for a duration of 5-7 days, with special attention to the prevention of hypoxia, fever, acidosis and deep venous thrombosis. The role of a 24-hour infusion of high-dose MPSS is still controversial, but it may be offered at the discretion of the treating surgeon to adult patients within 8 h of acute tSCI as a treatment option, especially in the case of very early decompression or incomplete tSCI.
摘要：
急性创伤性脊髓损伤(tSCI)是一种复杂的异质性损伤,受伤的程度，损伤严重程度,脊髓压迫的持续时间和程度，血压管理似乎影响神经系统的结果。尽管文献中的数据似乎在胸椎和胸腰椎tSCI患者的手术减压和脊柱固定的有效性方面不一致，但一些单中心研究表明，早期手术减压可能会导致更好的神经系统结局。尤其是不完全tSCI患者，建议尽快进行手术减压。然而,高能伤,尤其是胸廓的上层,可能太严重，不会受到手术减压的影响，这可能代表了多发性创伤患者的关键第二次打击。因此,在确定理想的手术时机之前,外科医生首先需要批判性地评估每位患者的神经功能恢复潜力.在手术干预之前必须实现循环稳定，和微创手术应该是首选。入院时应开始有创血压监测，建议将MAP维持在85至90mmHg之间，持续时间为5-7天，特别注意预防缺氧，发烧,酸中毒和深静脉血栓形成。24小时输注大剂量MPSS的作用仍然存在争议，但它可以由治疗外科医生酌情提供给急性tSCI的8小时内的成年患者作为治疗选择，特别是在非常早期的减压或不完整的tSCI的情况下。
