颈中央脊髓损伤综合征患者外科治疗时机对其疗效影响的研究

Effect of operation time after injury on the therapeutic effect in the syndrome of acute central cervical spinal cord injury

目的探讨颈中央脊髓损伤综合征(ACCS)患者外科治疗时机对其疗效的影响。方法选取2008年1月至2012年12月期间我院收治并接受手术治疗的ACCS患者46例,根据伤后至手术的时间分为早期组(伤后≤7 d手术,n=22)以及晚期组(伤后>7 d手术,n=24)。比较两组患者入院时、术后半年及末次随访时的美国脊柱损伤协会(ASIA)感觉与运动功能评分及改善率,采用Pearson相关系数分析伤后至手术的时间与ASIA感觉与运动评分的改善率之间的相关性。结果术后半年及末次随访时,早期组ASIA感觉与运动功能的评分及改善率均明显高于晚期组,差异有统计学意义(P<0.05)。术后半年及末次随访时,ASIA感觉评分改善率与伤后至接受手术的时间呈负相关(r=-0.782,r=-0.791,P<0.001),ASIA运动评分改善率与伤后至接受手术的时间呈负相关(r=-0.756,r=-0.768,P<0.001)。全部患者均无严重的并发症,两组的并发症发生率比较,差异无统计学意义(P>0.05)。结论颈中央脊髓损伤综合征患者伤后至手术时间与疗效成负相关,手术时间越早,感觉及运动功能的恢复效果越好,疗效及安全性令人满意。

Objective To analyze the effect of operation time after injury on the therapeutic effect in the syn-drome of acute central cervical spinal cord injury. Methods Forty-six patients with syndrome of acute central cervi-cal spinal cord injury treated surgically from January 2008 to December 2012 were enrolled in the study, which were divided into the early group （≤7 days from injury, n=22） and the late group （〉7 days from injury, n=24） according to interval from injury to surgery. The sensory, motor function score and recovery rates of American Spinal Injury Associ-ation （ASIA） on admission, at postoperative half-year and at final follow-up were compared between two groups. The Pearson correlation coefficient was performed to analyze the relationship of operation time after injury with the recov-ery rates of ASIA sensory and motor function score. Results The sensory and motor function score and recovery rates of ASIA at postoperative half-year and final follow-up were significantly higher in the early group than the late group （P〈0.05）. At postoperative half-year and final follow-up, the recovery rate of ASIA sensory function score were negatively correlated with interval from injury to surgery （r=-0.782, r=-0.791, P〈0.001）, and the recovery rate of ASIA motor function score were negatively correlated with interval from injury to surgery （r=-0.756, r=-0.768, P〈0.001）. All patients had no serious complications, and there was no significant difference in the incidence of complica-tions between two groups （P〉0.05）. Conclusion The therapeutic effect of the syndrome of acute central cervical spi-nal cord injury is negatively correlated with operation time after injury. The earlier the operation time is, the better the recovery of sensory and motor function will be. The therapeutic effect and safety are satisfying.