影响小儿脊髓栓系综合征疗效的Logistic回归分析  

Logistic regression analysis of the efficacy in children with tethered cord syndrome

作　　者：李伟[1] 罗意革[1] 黄名[1] Li Wei;Luo Yige;Huang Ming(Department of Pediatric Surgery, First Affiliated Hospital, Guangxi Medical University, Nanning 530021, China)

机构地区：[1]广西医科大学第一附属医院小儿外科,南宁530021

出　　处：《中华小儿外科杂志》2019年第4期298-303,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨影响小儿脊髓栓系综合征疗效的因素。方法回顾性分析293例脊髓栓系综合征患儿的临床资料,通过Logistic回归分析评价影响疗效的因素。293例患儿中,男140例,女153例;年龄2d至14岁,其中<6个月的患儿102例,6个月至3岁的患儿99例,≥3岁的患儿92例;脂肪瘤型124例,非脂肪瘤型169例。参考Hoffman神经功能分级将患儿的神经损害程度分为轻、中、重度;手术方法包括联合松解术、常规松解术、单纯修补术。本研究将疗效作为应变量,分为显效、有效、稳定、加重。通过有序多分类反应变量的Logistic回归分析,主要分析手术方式、病理类型、年龄及神经损害程度对疗效的影响。结果①手术方式:联合松解术OR值为66.92,常规松解术OR值为19.38,P值均<0.001;②病理类型:非肪脂瘤型OR值为2.17,P值为0.005;③年龄:<6个月其OR值为3.43,P值为0.000,6个月至3岁其OR值为2.27,P值为0.009;④神经损害程度:轻度的OR值为35.24,中度的OR值为12.86,P值均<0.001。影响疗效的因素依次是手术方式、神经损害程度、年龄、病理类型。其中手术方式以联合松解术比常规松解术疗效好,而单纯修补术的疗效最差;神经损害程度越轻、年龄越小疗效越好;非脂肪瘤型优于脂肪瘤型。结论小儿脊髓栓系综合征疗效的影响因素复杂多样,治疗上主张早期发现、早期诊断、早期手术。在硬膜腔内脊髓栓系松解术的基础上,进行硬膜外腔探查,松解硬膜外腔栓系,能进一步提高手术效率,能更大限度的改善神经功能。Objective To explore the factors associated with efficacy in children with tethered cord syndrome (TCS). Methods The clinical data of 293 TCS children were retrospectively reviewed and the factors affecting the efficacy evaluated by Logistic regression analysis. There were 140 boys and 153 girls with a median age of 9 months (2 days to 14 years). The age distribution was <6 months (n=102), 6 months~<3 years (n=99) and ≥3 years (n=92). And the clinical type was lipoma (n=124) and non-lipoma (n=169). According to the Hoffman’s neurofunctional classification, the severity of neurological injury was mild, moderate and severe. The surgical approaches included combination release, routine release and simple repair. Efficacy was assigned as a dependent variable of progression, stabilizing, regression and complete resolution. Factors related to the efficacy were analyzed with Logistic regression model, which focused on surgical approach, pathological classification, age and severity of neurological injury. Results① Surgical method: odds ratio (OR) value of combination release was 66.92 and routine release 13.98 (P<0.001);② Pathological classification: OR value of non-lipoma type was 2.17 (P=0.005);③ Age: OR value of age <6 months was 3.43 (P=0.000) and age from 6 months to 3 years 2.27 (P=0.009);④ Severity of neurological injury: OR value of mild form was 35.24 and median form 12.86 (P<0.001). The factors related to efficacy were surgical approach, severity of neurological injury, age and pathological type in a decreasing order of priority. Combination release had a priority over routine release while simple repair had obviously reduced efficacy. Mild neurological injury, younger age or non-lipoma type had better outcomes. Conclusions The factors related to efficacy of TCS vary greatly. Early observation, early diagnosis and early surgery are recommended. On the basic of intradural loosening, epidural exploration and adhesiolysis for TCS is considerably more efficacious in improving neurological functions tha

关 键 词：脊髓 综合征 回归分析 

分 类 号：R744[医药卫生—神经病学与精神病学]