颈脊髓损伤患者脊髓损伤严重程度与预后关系的分析  

Relationship between severity and prognosis in patients with cervical spinal cord injury

作　　者：吴昕峰[1] 宋卿鹏 靳培浩[1] 郎昭[1] 刘波[1] Wu Xinfeng;Song Qingpeng;Jin Peihao;Lang Zhao;Liu Bo(Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院脊柱外科,北京100035

出　　处：《骨科临床与研究杂志》2022年第3期168-172,共5页Journal Of Clinical Orthopedics And Research

基　　金：北京市医院管理中心青年人才培养“青苗”计划(QML 20200401)。

摘　　要：目的 探究颈脊髓损伤患者脊髓损伤严重程度与其预后的相关性。方法 2018年4月至2020年12月北京积水潭医院脊柱外科颈脊髓损伤患者217例临床资料,以院后1年死亡、存活评估患者预后。将出院后1年内死亡设定为预后不良。通过院后1年电话随访情况,将死亡患者纳入预后不良组(47例),存活患者纳入预后良好组(170例)。统计所有患者性别、年龄、至伤原因、治疗方式、是否合并伤等临床资料,根据美国脊柱损伤协会(ASIA)脊柱损伤严重程度分级将患者分为完全性脊髓损伤、不完全性脊髓损伤。分析患者院后1年内预后不良危险因素,探究脊柱损伤严重程度与其相关性。结果 两组脊髓损伤严重程度、损伤节段、合并脏器损伤、呼吸机支持、住院时间比较,差异有统计学意义(P<0.05)。死亡组完全性损伤、C1~C4损伤、合并脏器损伤发生率更高,且死亡组整体住院时间更长,呼吸机使用率更高(P<0.05)。Logistic回归分析显示损伤严重程度、合并脏器损伤、住院时间是影响院后1年内死亡的危险因素(P<0.05)。颈脊髓损伤严重程度与预后存在正相关性(r=0.253,P<0.001)。颈脊髓损伤严重程度预测预后不良敏感度为55.3%,特异度为73.5%,曲线下面积为0.644,约登指数为0.288。结论 颈脊髓损伤患者脊髓损伤严重程度与患者预后不良存在一定相关性,损伤越严重,预后不良概率越高,使用脊髓损伤严重程度预测预后不良有一定临床价值。Objective To explore the correlation between the severity and its prognosis in patients with cervical spinal cord injury.Methods The clinical data of 217 patients with cervical spinal cord injury in Department of Spine Surgery,Beijing Jishuitan Hospital,from April 2018 to December 2020 were collected retrospectively.In this study,death within one year after discharge was set as poor prognosis.The prognosis of patients was evaluated by death and survival within one year after hospitalization.The dead patients were included in the poor prognosis group(47 cases)and the surviving patients were included in the good prognosis group(170 cases)by one-year telephone follow-up.All patients were divided into complete spinal cord injury and incomplete spinal cord injury according to the severity classification of spinal injury of American Spinal Injury Association(Asia).The risk factors of poor prognosis within 1 year were analyzed after hospitalization,and the correlation between the prognosis and the severity of spinal injury were explored.Results There were significant differences in the severity of spinal cord injury,injured segments,combined organ injury,ventilator support and length of hospital stay between the two groups(P<0.05).The incidence of complete injury,C1~C4 injury and combined organ injury in the death group was higher,and the overall hospitalization time and ventilator use rate in the death group were longer(P<0.05).Logistic regression analysis showed that the severity of injury,combined organ injury and length of hospital stay were the risk factors of death within 1 year after hospitalization(P<0.05).There was a positive correlation between the severity and the prognosis of cervical spinal cord injury(r=0.253,P<0.001).The sensitivity was 55.3%;the specificity was 73.5%;the area under the curve was 0.644;and the Youden index was 0.288.Conclusion There is a certain correlation between the severity and poor prognosis of spinal cord injury in patients with cervical spinal cord injury.The more serious the injur

关 键 词：脊髓损伤 颈锥 预后 

分 类 号：R47[医药卫生—护理学]