急性颈脊髓损伤髓内出血水肿患者术后神经功能恢复的风险因素分析  

Analysis of risk factors for postoperative neurological recovery in patients with acute cervical spinal cord injury with intramedullary hemorrhagic edema

作　　者：段伟利 王淼 陈双辉 DUAN Wei-li;WANG Miao;CHEN Shuang-hui(First Department of Spine,Nanyang Hospital of Traditional Chinese Medicine,Nanyang,Henan 473000,China)

机构地区：[1]南阳市中医院独山院区脊柱一科,河南南阳473000

出　　处：《颈腰痛杂志》2024年第2期258-262,267,共6页The Journal of Cervicodynia and Lumbodynia

基　　金：南阳市中医院独山院区科研“苗圃”培育专项重点课题(编号:2023004)。

摘　　要：目的观察伴髓内出血水肿的急性颈脊髓损伤(cervical spinal cord injury,CSCI)患者的手术减压效果,并分析术后神经功能恢复不良的预测因素。方法回顾性分析该院于2018年3月~2022年3月收治的71例伴髓内出血水肿的急性CSCI患者资料,测量其术前MRI所示的髓内出血信号长度(intramedullary hemorrhage length,IHL)、髓内水肿信号长度(intramedullary edema length,IEL)、脊髓受压指数(maximum spinal cord compression,MSCC)等指标。于术前、术后3 d时,评价其ASIA运动评分(the ASIA motor score,AMS),并计算其AMS恢复率;术后6个月,以AIS分级改善≥1级判定为术后神经功能恢复(改善组),以AIS分级未改善甚至加重判定为术后神经功能未恢复(未改善组)。比较两组患者的相关资料,并采用多元Logistic回归分析得出CSCI患者术后神经功能恢复不良的预测因素。结果术后6个月,有54例(76.1%)患者的神经功能AIS分级改善了1级或以上,17例(23.9%)的AIS分级未见改善。两组患者的性别、年龄、创伤原因、伤后就诊时间、受伤至手术时间、术前AIS分级、软组织损伤情况和手术入路、术后康复训练情况等资料的差异均无统计学意义(P>0.05)。未改善组患者的术前IHL、IEL和MSCC指数显著高于改善组(P<0.05),损伤节段数显著多于改善组(P<0.05)。两组患者术前AMS评分无显著差异(P>0.05),但未改善组患者术后3 d的AMS评分和AMS改善率均显著低于改善组(P<0.05)。多元Logistic回归分析显示:术后3 d的AMS评分恢复率(OR=0.752,P=0.040)和术前IHL(OR=1.805,P=0.032)均是CSCA患者术后6个月神经功能恢复不良的独立预测因素。结论伴髓内出血水肿的CSCA患者脊髓损伤较重,术前MRI所见的IHL信号越长、术后3 d的AMS评分恢复率越低,则预示着患者术后远期神经功能恢复不良的风险越高。Objective To observe the effect of surgical decompression in patients with traumatic cervical spinal cord injury(CSCI)with intramedullary hemorrhage and edema,and to analyze the predictive factors of poor neurological recovery after surgery.Methods The data of 71 acute CSCI patients with intramedullary hemorrhage and edema admitted to our hospital from March 2018 to March 2022 were retrospectively analyzed,and the intramedullary hemorrhage length(IHL),intramedullary edema length(IEL),spinal cord compression index(MSCC)and other indicators shown in the preoperative MRI were measured.Before the operation and three days after the operation,the ASIA motor score(AMS)was evaluated and the AMS recovery rate calculated;six months after the operation,the postoperative neurological function recovery(improved group)was judged by the improvement of the AIS grading≥1 grade.The postoperative neurological function did not recover(unimproved group)when the AIS grade was not improved or even aggravated.The relevant data of the two groups of patients were compared,and multiple Logistic regression analysis was used to obtain the predictive factors of poor postoperative neurological recovery in CSCI patients.Results Six months after operation,54 patients(76.1%)had neurological function AIS grades improved by 1 grade or above,and 17 patients(23.9%)had no improvement in AIS grades.There were no significant differences in gender,age,trauma cause,post-injury visit time,injury-to-operation time,preoperative AIS grade,soft tissue injury,surgical approach,and postoperative rehabilitation training between the two groups(P>0.05).The preoperative IHL,IEL,and MSCC indexes in the unimproved group were significantly higher than those in the improved group(P<0.05),and the number of damaged segments was significantly more than that in the improved group(P<0.05).There was no significant difference in preoperative AMS score between the two groups(P>0.05),but the AMS score and AMS improvement rate of the unimproved group three days after operation

关 键 词：急性颈脊髓损伤 髓内出血水肿 MRI检查 T2加权像 AIS分级 预后不良 

分 类 号：R683.2[医药卫生—骨科学]