下颈椎损伤并发脊髓损伤手术治疗的预后及其影响因素

Surgical treatment of spinal cord injury with inferior cervical fracture-dislocation：prognosis and its affecting factors

中文关键词:  脊髓损伤  下颈椎损伤  预后  影响因素

英文关键词:Spinal cord injury  Cervical spine  Fractures and dislocations  Prognosis  Factors

中文摘要:

  【摘要】 目的：总结分析下颈椎损伤并发急性颈脊髓损伤手术治疗的预后及其影响因素，为临床治疗提供指导。方法：回顾性分析2005年4月~2010年2月我院收治的115例急性下颈椎损伤并发脊髓损伤患者的临床资料，利用多因素Logistic回归分析患者年龄、性别、损伤模式（高能量、低能量）、受伤至就诊时间、受伤至手术时间、损伤节段、损伤类型（骨折/脱位类型）、合并损伤、椎管侵占率、伤后8h内是否使用激素、院前转运是否使用颈托保护、术前是否行颅骨牵引以及手术方式对手术治疗此类损伤预后的影响。结果：本组男98例，女17例；年龄16~80岁，平均40.1岁。完全性损伤（ASIA分级A级）54例（47.0%），不完全性损伤（ASIA分级B、C、D级）61例（53.0%）。高能量损伤包括交通伤65例（56.5%）、高处坠落伤25例（21.7%）、重物砸伤8例（7.0%）；低能量损伤摔伤17例（14.8%）。颈椎外伤同时合并其他部位损伤28例（24.3%）。随访12~69个月，平均25.3个月，失访28例，随访率75.7%。单因素分析结果表明，受伤至就诊时间、受伤至手术时间、椎管侵占率、是否颈托保护、是否牵引和是否使用激素与急性脊髓损伤的预后相关（P＜0.1）；而与年龄、合并损伤等因素无明显相关（P＞0.1）。再经Logistic回归分析，受伤至就诊时间、受伤至手术时间、椎管侵占率和伤后8h内使用激素是影响脊髓损伤预后的主要因素（P＜0.05）。结论：受伤至就诊时间、受伤至手术时间、椎管侵占率和伤后8h内是否使用激素是影响下颈椎损伤并发脊髓损伤患者神功功能预后的主要因素。安全快速有效的院前急救、选择合适的手术时机、充分的脊髓减压和伤后8h内激素冲击治疗可以有效改善下颈椎损伤并发脊髓损伤的脊髓神经功能预后。

英文摘要:

  【Abstract】 Objective：To find out the factors that affect the prognosis of inferior cervical spinal injury with cervical spinal fractures or dislocations in order to guide clinical treatment of this kind of injury.Method：115 acute cervical spinal injury patients with cervical fractures or dislocations were followed up continuously between April 2005 and February 2010.The data were analyzed retrospectively which included age，sex，mode of injury，time to hospital，time to operation，injury level，classification of fractures or dislocations，canal clearance，steroids treatment，use of neck brace，traction and surgery approaches with logistic regression in order to find out the main factors that affect the prognosis.Result：115 cases were included，with 98 male cases（85.2%） and 17 female cases（14.8%）；ages ranged from 16 to 80 years，averaging 40.1 years.According to ASIA classification，there were 54 complete injury（ASIA A） cases（47.0%） and 61 incomplete injury（ASIA B，C，D） cases（53.0%），grade B for 17 cases（14.8%），grade C for 27 cases（23.5%），and grade D for 17 cases（14.8%）.Injury modes included traffic injury for 65 cases（56.5%），high fall for 25 cases（21.7%），fall damage for 17 cases（14.8%） and heavy pound injury for 8 cases（7.0%）.Multiple injuries were in 28 cases（24.3%）.Following up 12 to 69 months（average，25.3 months），28 cases were lost of follow-up，and the rate of follow-up was 75.7%.Factors including time to hospital，time to operation，canal clearance，use of steroids within 8 hours，use of neck brace and traction were screened out by univariate analysis（P＜0.1）.After logistic regression analysis in Back-forward Wald method，factors including time to hospital，time to operation，canal clearance and the use of steroids within 8 hours were left in the regression equation（P＜0.05），which were the four main factors that affected the prognosis of spinal cord injury（SCI）.Conclusion：Time to hospital，time to operation，canal clearance and use of steroids within 8 hours are factors that affect the prognosis of spinal cord injury.Safe，rapid and effective pre-hospital care，appropriate surgical intervention，adequate decompression and steroids applying within 8 hours after injury may effectively improve the prognosis of spinal cord injury with cervical spinal fractures or dislocations（SCI）.