胸腰段脊柱损伤并发脊髓损伤预后及影响因素分析

Factors influencing prognosis of thoracolumbar spinal injury combined with spinal cord injury

目的分析影响胸腰段脊柱损伤并发脊髓损伤手术治疗预后的因素，为临床治疗提供指导。方法回顾性分析2005年7月—2011年4月收治的77例急性胸腰段脊柱损伤并发脊髓损伤患者，其中男66例，女11例；年龄14—66岁，平均36.5岁。神经功能按照美国脊髓损伤协会（American Spinal Injury Association，ASIA）分级：A级31例，B级11例，C级10例，D级25例。通过单因素分析，筛选出可能影响脊髓损伤手术治疗预后的因素并纳入Logistic回归方程，筛选影响脊髓损伤预后的主要因素。结果随访时间24～96个月，平均55．5个月，失访15例，随访率81％。通过单因素分析筛选出骨折／脱位类型（P〈0.01）、是否合并损伤（P〈0.05）、伤后8h内是否使用糖皮质激素（P〈0.05）、院前转运是否使用保护装置及是否由专业医护人员转运（P〉0.1）、是否为完全损伤（P〈0.01）、就诊时间（P=0.055）、术前病程（P〈0.05）、椎管侵占率（P〈0.01）与脊髓神经功能恢复有相关性（P〈0.1）。再经Logistic回归分析，椎管侵占率（P〈0.01）及伤后8h内是否使用糖皮质激素（P〈0.05）是影响脊髓损伤预后的主要因素。结论伤后8h内激素冲击治疗、充分的脊髓减压可以有效改善胸腰段脊柱损伤并发脊髓损伤的脊髓功能预后。

Objective To investigate the factors influencing prognosis in surgical treatment of thoracolumbar spinal injury combined with spinal cord injury so as to assist in the clinical treatment. Methods A retrospective study was made on 77 cases of acute thoracolumbar spinal injury combined with spinal cord injury admitted from July 2005 to April 2011. There were 66 men and 11 women, aged 14-66 years （mean, 36.5 years）. Neurological performance evaluated using American Spinal Injury Association （ASIA） scale was grade A in 31 cases, grade B in 11 cases, grade C in 10 cases, and grade D in 25 cases. Potential factors affecting the prognosis of spinal cord injury were identified using univariate analysis and incorporated into the Logistic regression equation to filter out the main influencing factors. Results Fifteen cases dropped out at a mean 55.5-month follow-up （range, 24-96 months ） and follow-up rate was 81%. Univariate analysis selected fracture or dislocation types （ P〈0.01 ） , combined injury （ P〈0.05 ）, use of glucocorticoid within 8 hours postinjury （ P 〈 0.05 ） , standard transport by medical professionals （P〉0.1 ）, complete injury （P〈0.01 ） , visiting time （P =0.055） , cause of disease before operation （ P〈0.05 ） and canal encroachment rate （ P〈0.01 ） as predictors of neurologic recovery in spinal cord injury （P〈0.1 ）. Logistic regression analysis revealed significant prognostic factors were canal clearance （P〈0.01 ） and use of steroids within 8 hours postinjury （P〈0.05）. Conclusion Glucocorticoid pulse therapy within 8 hours postinjury and adequate spinal cord decompression may effectively imnrove the neurologic prognosis in thoracolumbar spinal injury with spinal card injury