基于急诊CT的创伤性颈髓损伤危险因素研究  

Research on risk factors of traumatic cervical spinal cord injury based on emergency CT

作　　者：周正 方熙 康健 李华 陈旭锋 周浩 李琳[1] ZHOU Zheng;FANG Xi;KANG Jian;LI Hua;CHEN Xufeng;ZHOU Hao;LI Lin(Department of Emergency and Critical Care Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029)

机构地区：[1]南京医科大学第一附属医院急诊与危重症医学科,江苏南京210029

出　　处：《南京医科大学学报(自然科学版)》2025年第3期346-352,359,共8页Journal of Nanjing Medical University(Natural Sciences)

基　　金：国家自然科学基金(82302794);江苏省基础研究计划自然科学基金(BK20220734);江苏省人民医院临床能力提升工程项目(JSPH-MC-2022-28)。

摘　　要：目的:基于急诊CT检查评估多发伤患者中创伤性脑损伤(traumatic brain injury,TBI)合并创伤性颈髓损伤(traumatic cervical spinal cord injury,TCSCI)的危险因素及其对预后的影响。方法:回顾性分析2020年1月—2022年12月南京医科大学第一附属医院急诊接诊时不排除TCSCI的218例多发创伤患者资料,根据入院后颈椎MRI结果,确定是否存在TCSCI,分为TCSCI和非TCSCI组。通过多因素Logistic回归分析,筛选出独立危险因素构建受试者工作特征(receiver operating characteristic,ROC)曲线预测模型并进行内部验证。结果:69例(31.7%)患者合并TCSCI,多因素Logistic回归分析结果显示,较高的头部简明损伤评分(head abbreviated injury scale,hAIS)(OR=1.552,95%CI:1.101~2.188)、下颈椎损伤分类(sub-axial injury classification,SLIC)评分(OR=1.235,95%CI:1.006~1.517)和截瘫症状(OR=3.810,95%CI:1.115~13.020)是TCSCI的独立危险因素。预测模型ROC曲线下面积为0.900(95%CI:0.859~0.941),通过Hosmer-Lemeshow检验评价模型效果,提示预测模型区分度和校准度均较好。结论:hAIS、SLIC评分和截瘫症状是多发创伤患者合并TCSCI的独立危险因素,针对不排除TCSCI的多发创伤患者,进行急诊CT检查并评估h AIS、SLIC评分、截瘫症状可能有效筛选出高危TCSCI患者。Objective:To evaluate the risk factors and prognostic impact of traumatic brain injury(TBI)combined with traumatic cervical spinal cord injury(TCSCI)in patients with multiple traumas based on emergency CT.Methods:A retrospective analysis was conducted on the data of 218 patients with multiple traumas who were admitted to the emergency department of the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2022,in whom TCSCI was not excluded.Patients were divided into the TCSCI group and non-TCSCI group based on cervical MRI results.Multivariate logistic regression analysis was used to screen for independent risk factors,construct a receiver operating characteristic(ROC)curve prediction model,and perform internal validation.Results:TCSCI was identified in 69 patitents(31.7%).Multivariate logistic regression analysis showed that higher head abbreviated injury scale(hAIS)scores(OR=1.552,95%CI:1.101-2.188),sub-axial injury classification(SLIC)scores(OR=1.235,95%CI:1.006-1.517),and paraplegia symptoms(OR=3.810,95%CI:1.115-13.020)were independent risk factors for TCSCI.The ROC curve for the predictive model showed an area under the curve(AUC)of 0.900(95%CI:0.859-0.941).The Hosmer-Lemeshow test confirmed good discriminative ability and calibration of the model.Conclusion:hAIS,SLIC scores,and paraplegia symptoms are independent risk factors for TCSCI in patients with multiple traumas.Emergency CT combined with assessment of hAIS,SLIC scores,and paraplegia may effectively identify high-risk TCSCI patients with multiple traumas where TCSCI cannot be excluded.

关 键 词：创伤性颈髓损伤 急诊CT 头部简明损伤评分 下颈椎损伤分类 截瘫症状 危险因素 

分 类 号：R681.54[医药卫生—骨科学]