老年人急性中央颈脊髓损伤预后的临床研究

Prognosis of acute central cervical cord injury in the senile

目的探讨年龄对急性中央颈脊髓损伤预后的影响以及老年人急性中央颈脊髓损伤的临床特点。方法回顾性对比分析８９例急性中央颈脊髓损伤，其中老年患者（６０～８１岁）２９例，占３２．６％；非老年患者（２５～５９岁）６０例。结果老年组中，四肢型２７例，发生率为９３．１％，高于非老年组的６６．７％（４０／６０）（χ２＝５．９９１，Ｐ＜０．０５）。年龄与初诊及最后随访时美国脊柱损伤协会（ＡＳＩＡ）评分（老年组分别为３７．４及７６．６分，非老年组为４３．８及８７．６分）呈负相关，差异有显著性（ｒ＝－０．２６３，Ｐ＝＜０．０５及ｒ＝－０．３４７，Ｐ＜０．０１）。２例死亡者为老年患者。老年组四肢型损伤２７例中，合并严重颈椎退行性变２４例，发生率（８８．９％）明显高于非老年组（Ｐ＜０．０５）。结论老年人急性中央颈脊髓损伤预后较差。

Objective This clinical study was designed to determine the effect of age upon the prognosis of acute central cervical cord injury and to delineate the clinical characteristics of this syndrome in the senile. Methods A total of 89 patients with acute central cervical cord injury were retrospectively analyzed. There were 29 patients older than 60 years, accounting for 32 6%, and 60 patients younger than 59 years. Results In the older group, there were 27 patients (93 1%) with tetraplegia as compared with the younger group, there were 40 patients (66 7%) with tetraplegia correlated ( χ 2=5 991, P <0 05). Age of the patients was negatively to the American Spinal Injury Association(ASIA) score at either the first admission ( r =-0 263, P <0 05) or the final follow up ( r = -0 347, P <0 01). Both deaths were the senile patients. Among 27 senile patients with tetraplegia, there were 24 with radiographic findings of severe cervical spinal degeneration. This incidence (88 9%) were higher than that in the younger group ( χ 2=5 688, P <0 05). Conclusions Poorer prognosis is associated with the senile patients with acute cervical cord injury.