综合康复治疗创伤性颈脊髓中央损伤综合征疗效的多维度评价

Multi-dimensional efficacy evaluation of comprehensive rehabilitation in patients with traumatic central cord syndrome

中文关键词:  脊髓损伤  中央综合征  综合康复训练  疗效评估

英文关键词:Spinal cord injury  Central cord syndrome  Rehabilitation treatment  Efficacy evaluation

中文摘要:

  【摘要】 目的：观察综合康复治疗对创伤性颈脊髓中央损伤综合征（traumatic central cord syndrome，TCCS）患者神经功能和生活质量的改善情况，并进行多维度疗效评价。方法：回顾性分析2016年1月~2021年12月我院收治的90例TCCS患者，其中男74例，女16例，年龄27~85岁（56.6±10.7岁），根据综合康复治疗前是否接受了颈椎手术分为术后康复组（82例）和单纯康复组（8例）。两组患者在年龄、性别、脊髓损伤程度等方面均无统计学差异（P＞0.05）。所有患者均接受1~3个月的物理治疗、作业治疗、膀胱管理等综合康复治疗。收集患者入院和出院时的美国脊髓损伤协会（American Spinal Injury Assosication，ASIA）残损分级（ASIA impairment scale，AIS）和运动评分（motor score，MS）、国际功能分类康复组合（ICF-RS）评分，并进行组间比较；统计患者膀胱功能变化和并发症情况，全面评估TCCS患者的神经功能恢复情况，多维度评价康复措施的疗效。结果：综合康复治疗前AIS分级C级48例，D级42例，治疗后27例患者C级改善为D级（术后康复组23例，单纯康复组4例），余63例AIS分级无变化，但治疗后下肢和上肢的MS较治疗前显著提高（P＜0.05）。组间MS评分无统计学差异（P＞0.05）。患者ICF-RS所有条目中，“b280痛觉”、“d240 控制应激和其他心理需求”评分变化治疗前后无统计学差异（P＞0.05）；余条目评分均较治疗前有提高，且有统计学差异（P＜0.05），组间比较无统计学差异（P＞0.05）。33例患者由导尿恢复至自主排尿。脊髓损伤并发症占比前2名的是痉挛（54.4%）和神经痛（23.3%），痉挛与MS恢复程度无显著相关性（P=0.06）。结论：综合康复治疗对TCCS患者神经功能恢复有明显促进作用，无论是术后康复还是单纯康复的TCCS患者其综合功能均获得了明显改善。ICF-RS条目细致，适于TCCS这一特殊类型脊髓损伤患者的评估。

英文摘要:

  【Abstract】 Objectives: To observe the improvements on neurological function and quality of life in traumatic central cord syndrome(TCCS) patients following comprehensive rehabilitation therapy, and to evaluate the effects from multi-dimension. Methods: A retrospective analysis was performed on 90 TCCS patients admitted and treated in our hospital from January 2016 to December 2021. There were 74 males and 16 females, aged 27 to 85 years(56.6±10.7 years). The patients were divided into postoperative rehabilitation group(82 cases) and simple rehabilitation group(8 cases) according to whether they had received cervical surgery before comprehensive rehabilitation therapy. There were no significant differences in age, gender and grade of spinal cord injury between the two groups(P>0.05). All the patients received comprehensive rehabilitation therapy such as physical therapy, occupational therapy(OT), and bladder management for 1 to 3 months. ASIA impairment scale(AIS) according to the American Spinal Injury Association: International Standards for Neurological Classification of Spinal Cord Injury(ISNCSCI), motor score(MS) as well as International Functional Classification Rehabilitation Combination(ICF-RS) scores were assessed and compared between the two groups. The changes of bladder function and the occurrence of complications were counted to comprehensively evaluate the recovery of neurological function in TCCS patients and judge the efficacy of the rehabilitation measures from multi-dimension. Results: Before rehabilitation therapy, 48 patients were of AIS grade C and 42 were of grade D. After comprehensive rehabilitation therapy, of all the patients, 27 patients(23 in the postoperative rehabilitation group and 4 in the simple rehabilitation group) of AIS grade C improved to grade D, and the AIS grades of other patients remained unchanged, while their MSs of lower limb and upper limb at discharge were significantly higher than those before rehabilitation therapy(P<0.05). There was no significant difference between groups in MS(P>0.05). Among the items of ICF-RS, the scores of all items but "b280 Sensation of pain, d240 Handling stress and other psychological demands" after rehabilitation improved than before rehabilitation with statistical differences(P<0.05). There was no significant difference in ICF-RS scores between groups(P>0.05). A total of 33 patients recovered from catheterization to spontaneous urination. The top two complications of spinal cord injury were spasm(54.4%) and neuralgia(23.3%). There was no significant correlation between the occurrence of spasm and the degree of MS recovery(P=0.06). Conclusions: Comprehensive rehabilitation therapy can significantly promote the recovery of neurological function in TCCS patients, and the comprehensive functions of both postoperative rehabilitation and simple rehabilitation TCCS patients can be significantly improved. ICF-RS with detailed items is suitable for the evaluation of the spinal cord injury in TCCS.