早期康复干预对脊髓损伤后康复时间的影响

Effect of early rehabilitation intervention on the recovery time after spinal cord injury

中文关键词:  脊髓损伤  早期康复  康复时间  并发症  ASIA残损分级

英文关键词:Spinal cord injury  Early rehabilitation  Rehabilitation time  Complication  ASIA impairment scale

中文摘要:

  【摘要】 目的：观察脊髓损伤后康复治疗的起始时间对不同节段脊髓损伤（SCI）病例达到康复目标所需的时间、残损分级变化和并发症发生率的影响。方法：采用多家医疗机构协作进行前瞻性病例观察方法，事先预定康复方案，同时开始纳入SCI病例。病例入组后，参照国际标准为其制定康复目标和方案。在开始康复训练后进行跟踪观察，包括记录康复时间（受伤至达到康复目标所需时间），评估康复前后的ASIA残损分级及并发症的发生率。2009年1月~2012年12月4年里先后共入组观察521例患者，男419例，女102例，年龄38.5±12.1岁（18~74岁），随访20±8个月（10~38个月）。按受伤至入组的时间长短，将病例分为围手术期组、术后组和延迟组。各组按SCI节段不同再细分为高位颈髓损伤、低位颈髓损伤、胸髓损伤、腰骶段损伤四群。最终将观察结果进行组内组间对比分析。结果：在围手术期组的高位颈髓损伤、低位颈髓损伤、胸髓损伤和腰骶损伤病例中，运动完全损伤者（A、B级）所需康复时间中位数分别为238d、160d、97d和62d，运动不完全损伤者（C、D级）所需康复时间分别为153d、128d、72d和46d。术后组各群SCI的康复时间比围手术期组相同群SCI增加16~30d（P<0.05）。在延迟组，各群SCI的康复时间较前两组均明显增加（P＜0.05），特别是低位颈髓损伤、胸髓损伤和腰骶损伤A、B级病例较围手术期组成倍增加（P<0.05）。同一组患者中，相同ASIA残损分级，损伤平面越低，康复时间越短（P<0.05）；同一损伤平面，损伤越重，康复时间越长（P<0.05）。在达到康复目标时，A~D级病例中有一个级别改善的比率分别为A级3.8%、B级13.6%、C级34.0%和D级7.7%，有两个级改善的比率为A级2.35%、B级2.1%、C级0.09%和D级0%。围手术期康复组压疮、下肢深静脉血栓、下尿路感染和肺部感染的发生率分别为6.2%、5.5%、15.4%和11.1%，均明显低于另外两组（P<0.05）。结论：早期康复干预能降低SCI并发症的发生率，从而缩短康复时间，但对残损分级变化无明确影响。SCI康复所需时间大约为3~9个月，损伤平面越高、程度越重，所需康复时间越长。运动完全损伤者康复前后ASIA残损分级无明显变化。

英文摘要:

  【Abstract】 Objectives: To investigate the effect on the required rehabilitation time(RT), the change of ASIA impairment scale(AIS) and the incidence of complications of the starting time of treatment on rehabilitation after spinal cord injury. Methods: A collaborative prospective and follow-up study was performed. After the patients entered the study, the goal and plan of rehabilitation were set according to the international standard immediately, and rehabilitation training was then started. Through prospective observation, the RT, from onset injury to the time point when reaching the rehabilitation goal, was recorded. AIS changes and complications were also recorded. From January 2009 to December 2012, 521 cases of traumatic SCI were totally recruited, the average age was 38.5±12.1(range, 18-74) years old, there were 419 males and 102 females, with a mean follow-up time of 20±8(range, 10-38) months. The patients were divided into peri-operation, post-operation and delayed rehabilitation groups with respect to the starting time of rehabilitation. The cases in each group were further designated as upper cervical SCI, lower cervical SCI, thoracic SCI and lumbar-sacral injury according to the injury levels. The results of RT, AIS and complications among three groups were analyzed. Results: In peri-operation group, the median of RT for upper and lower cervical SCI, thoracic SCI and lumbar-sacral injury cases after complete motor injury was 238d, 160d, 97d and 62d, respectively, while 153d, 128d, 72d and 46d respectively for incomplete motor injury cases. There were 16-30 days increase of RT in post-operation group(P<0.05). Compared with the other two groups, further RT extension were found in the delayed group. For lower cervical SCI, thoracic SCI and complete motor lumbar sacral injury cases, the RT in the delayed group even doubled as long as that of the peri-operation group(P<0.05). When reaching rehabilitation goals, 3.8%, 13.6%, 34% and 7.7% of the Grade A, B, C and D cases respectively achieved one grade of improvement, while 2.35%, 2.1%, 0.09% and 0% of the Grade A, B, C and D cases respectively got two grades improvement. Early rehabilitation could decrease the incidence of sore, deep vein thrombosis, lower urinary tract infection and lung infection to 6.2%, 5.5%, 15.4% and 11.1% respectively in the peri-operation group. Conclusions: Early rehabilitation decreases the incidence of complications, shortens the RT of SCI patients. Rehabilitation training, no matter starting early or late, has equal effect on the improvement of AIS.