手术治疗伴有髓内出血水肿的创伤性颈脊髓损伤的疗效及预后预测因素

Therapeutic experience and predictor of neurological recovery of traumatic cervical spinal cord injury with hematoma and edema

中文关键词:  颈脊髓损伤  出血  水肿  临床疗效  预测因素

英文关键词:Cervical spinal cord injury  Clinical efficacy  Hematoma  Edema

中文摘要:

  【摘要】 目的：分析伴有髓内出血水肿的创伤性颈脊髓损伤（CSCI）的手术疗效，探讨其预后预测因素。方法：回顾性分析2014年1月～2019年12月在我院接受手术治疗的伴髓内出血水肿的创伤性CSCI患者83例。术前和术后6个月依据美国脊髓损伤协会残障等级[American Spinal Injuries Association（ASIA） impairment scale，AIS]进行神经功能评估，术后6个月AIS改善至少1级视为有神经功能恢复，将患者分为神经功能恢复组和未恢复组。收集两组患者的年龄、性别、术前AIS分级、术前ASIA运动评分（AMS）、术前MRI上水肿信号长度（IEL）、术前MRI髓内出血信号长度（IHL）、术前脊髓受压分数（MSCC）、损伤机制、受伤至就诊时间、受伤至接受手术时间、是否有软组织损伤、损伤节段、手术入路、术后3d的AMS、术后3d的AMS恢复率、术后康复治疗、术后6个月的AIS分级，对各变量进行组间单因素分析，筛选P＜0.05的变量纳入二分类Logistic回归以确定预后预测因素。结果：术前AIS分级为A～C级，60例患者在术后6个月时AIS分级获得改善，改善率为72.3%。两组患者年龄、性别、术前AIS分级无统计学差异（P＞0.05）。单因素分析显示两组术前IEL、IHL、MSCC、损伤节段、术后3d的AMS、术后3d的AMS恢复率有统计学差异（P＜0.05），术前AMS、损伤机制、受伤至就诊时间、是否有软组织损伤、受伤至手术时间、手术入路、是否行术后康复治疗无统计学差异（P>0.05）。二分类Logistic回归分析结果显示术后3d的AMS恢复率[（odds ratio（OR） 1.331，95%CI 1.063～1.665]和IHL（OR 0.773，95%CI 0.653～0.915）是术后6个月神经功能恢复的预测因素。结论：手术治疗有助于改善伴有髓内出血水肿的创伤性CSCI患者神经功能，术前IHL低、术后3d的AMS改善率高的患者术后6个月神经功能恢复较好。

英文摘要:

  【Abstract】 Objectives: To investigate the surgical effects of traumatic cervical spinal cord injury(CSCI) with intramedullary hemorrhage and edema and analyze the predictor of neurological recovery. Methods: Retrospective analysis was performed on 83 cases of traumatic CSCI patients with intramedullary hemorrhage and edema who received surgical treatment in our hospital from January 2014 to December 2019. Neurological function was assessed through American Spinal Association(ASIA) impairment scale(AIS), and the patients enrolled had grade A-C of AIS with a follow-up time of more than 6 months. The AIS improvement of at least 1 level at 6 months after surgery was regarded as neurological function recovery. The patients were divided into recovery group and non-recovery group. General information was collected, such as age, gender, and observation indicators including preoperative AIS grade, preoperative ASIA motor score(AMS), preoperative intramedullary edema length(IEL), preoperative intramedullary hematoma length(IHL), preoperative maximum spinal cord compression(MSCC), injury mechanism, time from injury to hospital, time from injury to decompression, soft tissue injury, injured segments, surgical approach, AMS 3 days after decompression, AMS improvement rate 3 days after decompression, postoperative rehabilitation, and AIS grade 6 months after decompression. The number of patients with improved AIS score 6 months after surgery was counted, and the variables were analyzed by single factor analysis between groups. Variables with P<0.05 were included in binary logistic regression. Results: AIS improved in 60 patients within 6 months after the operation, with an improvement rate of 72.3%. There was no statistically significant difference in the age, gender and preoperative AIS grade between the two groups(P>0.05). In univariate analysis, there were statistically significant differences in AMS 3 days after surgery, AMS recovery rate, preoperative IEL, preoperative IHL, preoperative MSCC(P<0.05), and injured segments, while there was no statistically significant difference in preoperative AMS, injury mechanism, time from injury to hospital, soft tissue injury, time from injury to decompression, surgical approach, and postoperative rehabilitation(P>0.05). Variables with P<0.05 were included in logistic regression analysis, and the results showed that AMS recovery rate(odds ratio 1.331, 95%CI 1.063-1.665) and preoperative IHL(odds ratio 0.773, 95%CI 0.653-0.915) were the predictors of neurological function recovery 6 months after surgery. Conclusions: Surgical treatment is helpful to improve the neurological function of patients with haemorrhagic edematous CSCI, and the AMS improvement rate and preoperative IHL are the predictors for the neurological function recovery of patients 6 months after surgery.