ICU上颈椎损伤患者的生存率与临床特征的关系研究

The association between survival rate and clinical features of patients with upper cervical spine injury in ICU

目的评价ICU治疗的上颈椎损伤患者的生存率与临床特征之间的关系。方法选取在我院骨科ICU进行急救的138例上颈椎损伤患者进行回顾性分析。收集患者的临床资料，包括年龄、性别、致伤原因、心肺骤停（CPA）情况、美国脊髓损伤协会损伤分级（AIS）与损伤严重度评分（ISS）。评估患者上颈椎损伤的分布和形态、患者人院和出院时的脊髓损伤情况。将患者分为两组：出院患者组（生存组）和院内死亡患者组（死亡组），比较两组患者的临床特征。结果上颈椎损伤的发病率为18．8％（138／736），患者平均年龄（59．7±9．5）岁，平均ISS为（34．7±5．2）分，总生存率为77．5％（107／138）。45例（32．6％）患者完全瘫痪（AISA级）。常见的上颈椎损伤是C2骨折[67．4％（93／138）]，C2骨折最常见的类型是Ⅲ型齿状突骨折[27．5％（38／138）]。共有86例（62．3％）患者发生脊髓损伤（AISA—D级），15例（10．8％）患者神经功能改善（AISA级2例，B级3例，C级10例）。死亡组患者年龄（t=2．681，P=0．039）、完全瘫痪（AISA级）患者比例（x^2=22．457，P〈0．001）、CPA发生率（x^2=74．965，P〈0．001）和ISS（t=35．720，P〈0．001）明显高于生存组。结论最常见上颈椎损伤是Ⅲ型齿状突骨折，超过60％的患者存在脊髓损伤。最常见的瘫痪程度是AISA级。与年轻人比较，老年人更容易发生上颈椎损伤，病死率明显增高。死亡患者完全瘫痪比例、ISS和CPA发病率明显提高。

Objective To evaluate the association between survival rate and clinical features in patients with upper cervical spine injuries treated with ICU. Methods A retrospective analysis of 138 patients with upper cervical spine injuries in the Department of Orthopedics ICU in our hospital was included. The clinical data were collected, including age, gender, injury reason, the cardiopulmonary arrest（CPA） incidence, the American Spinal Cord Injury Association classification （AIS） and the Injury Severity Score（ISS）. The distribution and morphology of upper cervical injuries in patients, and spinal cord injuries at admission and discharge were respectively assessed. The patients were divided into two groups： discharge group （survival group） and in- hospital death group （death group）. The clinical characteristics were compared between the two groups. Results The incidence of upper cervical injury was 18.8% （138/736）. The average age of the patients was（59.7± 9.5） years. The average ISS was （34.7 ± 5.2） , and the overall survival rate was 77.5% （107/138）. 45 （32.6%） patients were completely paralyzed （ AIS is A ）. The most common type of upper cervical injury was C2 fracture [ 67.4% （93/138） ] , and the most common type of C2 fracture was type Ⅲ odontoid fracture [ 27.5% （38/138） 1.86 （62.3%） patients had spinal cord injury （AIS A -D grade）. Neurological function was improved in 15 （10.8%） patients（2 of AIS A, 3 of B, 10 of C）. The age of the death group （t = 2. 681, P = 0. 039 ） , the proportion of patients with complete paralysis （ AIS A, x^2 = 22. 457, P 〈 0.001）, the incidence ofCPA （x^2 =74.965, P〈0.001） and ISS （t =35.720, P〈0.001） were significantly higher than those in the survival group. Conclusion The most common fracture of the upper cervical spine is type Ⅲ odontoid fracture, and more than 60% of the patients have spinal cord injuries. The most common degree of paralysis is AIS class A. Compared with the young, the elderly are more likely to suffer from upper cervical injury, and the mortality rate is significantly higher. The proportion of complete paralysis, ISS and CPA incidence of the dead patients improve obviously.