脊髓锐器伤患者中长期随访研究

Middle and long term functional prognosis follow-up in patients with spinal cord stab injury

中文关键词:  脊髓锐器伤  康复  美国脊髓损伤协会评分  中长期随访  脊髓空洞

英文关键词:Spinal cord stab injury  Rehabilitation  ASIA  Medium and long term follow-up  Syringomyelia

中文摘要:

  【摘要】 目的：探讨脊髓锐器伤患者中长期神经功能恢复特点，为临床康复工作提供参考。方法：回顾性分析中国康复研究中心北京博爱医院2002年1月~2016年12月收治的脊髓锐器伤患者61例，其中男49例，女12例，受伤年龄28.9±11.7岁（8~53岁）。颈脊髓损伤15例，胸脊髓损伤39例，腰脊髓损伤7例，均进行了无差别的全面系统的康复治疗。平均随访时间8.6±5.4年（2~30年）。通过美国脊髓损伤协会（American Spinal Cord Injury Association，ASIA）评分标准评估其伤后1个月内、2年以上神经功能恢复情况。按照运动与感觉损伤完全性与否评估伤后1个月和2年以上的损伤程度分级（ASIA impairment scale，AIS），统计各分级患者例数；并且评估伤后1个月、3个月、6个月、1年、2年以上的运动评分（ASIA motor score，AMS）、轻触觉（light touch，LT）、针刺觉（pin prick，PP），比较其与前一次随访数据的差异。同时收集患者随访期内脊髓MRI资料，观察其是否出现脊髓空洞。结果：各损伤程度AIS分级内脊髓锐器伤患者例数为，伤后1个月内A级21例、B 级16例、C级7例、D级17例，受伤2年后A级16例、B级9例、C级11例、D级24例、E级1例。伤后1个月AMS、LT、PP评分分别为57.6±22.5、69.9±25.2、68.0±25.3；3个月AMS、LT、PP分数分别为60.8±23.1，71.5±25.3，70.0±25.1；6个月AMS、LT、PP分数分别为68.3±23.2、74.9±24.9、72.9±24.7；1年AMS、LT、PP分数分别为69.6±23.2、75.3±25.1、73.2±24.8；2年后分数AMS、LT、PP分别为67.9±23.4、73.7±26.1、71.7±26.2。患者受伤2年后与伤后1个月内AIS分级无统计学差异（P>0.05）；伤后前6个月AMS、LT、PP改变有统计学差异（P＜0.05），1年后与6个月时ASIA评分无统计学差异（P＞0.05），2年后与1年时ASIA评分无统计学差异（P>0.05）。随访到完整MRI资料19例，其中6例出现脊髓空洞，脊髓空洞发生率为31.58%（6/19）。发现脊髓空洞的时间为2个月~10年。本组未发现死亡病例。结论：脊髓锐器伤患者神经功能提高多发生在伤后半年内，随时间延长神经功能各项指标改善趋于停滞，部分患者出现脊髓空洞改变。

英文摘要:

  【Abstract】 Objectives: To investigate the middle and long term prognosis of patients with spinal cord stab injury, and to provide evidence for clinical and rehabilitation practice. Methods: From January 2002 to December 2016, a total of 61 patients with spinal cord stab injury in China Rehabilitation Research Center were enrolled with an average age of 28.9±11.7（8-53）years old. 15 were with cervical spinal cord injury, 39 with thoracic and 7 with lumbosacral spinal cord. All received comprehensive rehabilitation. The follow-up time was 8.6±5.4 years (2-30 years) in average. The international standards published by American Spinal Cord Injury Association(ASIA) were used to evaluate the neurological function of patients at 1 month, 3 months, 6 months, 1 year and more than 2 years after stab injury. The ASIA standards included ASIA impairment scale(AIS), ASIA motor score(AMS), light touch(LT) as well as pin prick(PP). Number of patients in different AIS grades at more than 2 years and 1 month was compared by using χ2 test. AMS, LT, PP were divided into 5 groups according to the different follow-up time and t-test was used. Magnetic resonance imaging(MRI) data were collected to identify syringomyelia. Results: Number of patients in different AIS grades at 1 month was 21 in grade A, 16 in grade B, 7 in grade C while 17 in grade D; AIS score at more than 2 years was 16 in grade A, 9 in grade B, 11 in grade C, 24 in grade D while 1 in grade E. AMS, LT, PP scores at 1 month were 57.6±22.5, 69.9±25.2, 68.0±25.3; 60.8±23.1, 71.5±25.3, 70.0±25.1 at 3 months; 68.3±23.2, 74.9±24.9, 72.9±24.7 at 6 months; 1 year were 69.6±23.2, 75.3±25.1, 73.2±24.8; 67.9±23.4, 73.7±26.1, 71.7±26.2 at more than 2 years. There was no statistic difference(P>0.05) of patients number in different AIS grades at 1 month and at more than 2 years; while there was statistic difference(P<0.05) in group 1 month vs 3 months and group 3 months vs 6 months in AMS, LT and PP. There was no statistic difference (P>0.05) in group 6 months vs 1 year and group 1 year vs 2 years in AMS, LT and PP. The occurrence rate of syringomyelia after spinal cord stab injury was 31.58%(6/19), which was discovered from 2 months to 10 years after injury. No death was discovered during follow-up. Conclusions: The improvement of neurological function in patients with spinal cord stab injury mostly occurred within 6 months after injury, and the neurological function improvement tends to be stable as time goes by, while some patients showed syringomyelia.