创伤性脊髓损伤预后的危险因素分析  

Risk factors for prognosis of traumatic spinal cord injury

作　　者：贺少杰 赵振宇 余信诚 李伟宽 孔畅[2] 马航展 查丁胜[1,3] He Shaojie;Zhao Zhenyu;Yu Xincheng;Li Weikuan;Kong Chang;Ma Hangzhan;Zha Dingsheng(Department of Orthopaedics,The First Hospital Affiliated to Jinan University,Guangzhou 510630,China;Department of Orthopaedics,Panyu Hospital of Chinese Medicine,Guangzhou 511400,China;Department of Orthopedics,The Shunde Hospital Affiliated to Jinan University,Foshan 528303,China)

机构地区：[1]暨南大学附属第一医院骨科,广州510630 [2]广州市番禺区中医院骨科,广州511400 [3]暨南大学附属顺德医院骨科,佛山528303

出　　处：《中华创伤骨科杂志》2024年第7期590-596,共7页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金青年项目(81401766);广州市科技项目(201904010060);佛山市十四五医学重点专科建设项目。

摘　　要：目的分析创伤性脊髓损伤(TSCI)后6个月预后的危险因素。方法回顾性分析2017年1月至2021年8月暨南大学附属第一医院骨科收治的133例TSCI患者资料。根据患者损伤后6个月较入院时脊髓损伤美国脊髓损伤协会(ASIA)分级的改善情况分为改善组(n=82)与非改善组(n=51)。纳入两组患者的性别、年龄、MRI脊髓信号改变长度、最大椎管压迫度(MCC)、最大脊髓压迫度(MSCC)、脑与脊髓损伤中心(BASIC)分级、伤后3 d内中性粒细胞与淋巴细胞计数比值(NLR)、伤后3 d内ASIA分级、术后3 d平均动脉压(MAP)、是否发生并发症等指标进行单因素和logistic回归分析,分析TSCI患者损伤后6个月预后的危险因素。结果单因素分析结果:改善组患者的MRI脊髓信号改变长度、MCC、MSCC、BASIC分级、伤后3 d内NLR、伤后3 d内ASIA分级、术后3 d MAP、有无发生并发症与非改善组比较,差异均有统计学意义(P<0.05)。logistic回归分析结果:伤后3 d内NLR(OR=0.463,95%CI:0.287~0.748,P=0.002)和伤后3 d内ASIA分级(OR=11.684,95%CI:1.684~81.086,P=0.013)、术后3 d MAP(OR=2.224,95%CI:1.306~3.787,P=0.003)是TSCI患者损伤后6个月预后的危险因素。结论对于TSCI患者,伤后3 d内NLR、ASIA分级、术后3 d MAP是伤后6个月预后的危险因素。ObjectiveTo analyze the risk factors for 6-month prognosis of traumatic spinal cord injury(TSCI).MethodsA retrospective analysis was conducted of the 133 patients with TSCI who had been admitted to Department of Orthopaedics,The First Hospital Affiliated to Jinan University from January 2017 to August 2021.The patients with TSCI were categorized into an improved group(n=82)and a non-improved group(n=51)according to the improvements in the American Spinal Injury Association(ASIA)grading between admission and 6 months after injury.To identify the risk factors that might affect the prognosis of TSCI patients at 6 months after injury,univariate and logistic regression analyses were conducted of indicators such as gender,age,length of MRI spinal cord signal change,maximum canal compromise(MCC),maximum spinal cord compression(MSCC),brain and spinal cord injury center(BASIC)score,neutrophil-to-lymphocyte ratio(NLR)within 3 days after injury,ASIA grading within 3 days after injury,mean arterial pressure(MAP)at 3 days after operation,and presence of complications.ResultsThe univariate analysis showed significant differences between the improved and non-improved groups in length of MRI spinal cord signal change,MCC,MSCC,BASIC,NLR within 3 days after injury,ASIA grading within 3 days after injury,MAP at 3 days after operation,and presence of complications(all P<0.05).The logistic regression analysis showed that NLR(OR=0.463,95%CI:0.287 to 0.748,P=0.002)and ASIA grading(OR=11.684,95%CI:1.684 to 81.086,P=0.013)within 3 days after injury,as well as MAP at 3 days after operation(OR=2.224,95%CI:1.306 to 3.787,P=0.003),were risk factors affecting the 6-month prognosis in TSCI patients.ConclusionThe NLR and ASIA grading within 3 days after injury,and MAP at 3 days after operation are risk factors that may affect the prognosis of TSCI patients at 6 months after injury.

关 键 词：创伤性 脊髓损伤 预后 相关因素 

分 类 号：R651.2[医药卫生—外科学]