ABCD分类在指导无骨折脱位型颈髓损伤诊疗中的优势

Advantage of ABCD classification in guiding diagnosis and treatment of cervical spinal cord injury without fracture or dislocation

目的通过对比下颈椎损伤分型（SLIC）评分和ABCD分类在无骨折脱位型颈髓损伤治疗的指导效果，进而证明ABCD分类在指导无骨折脱位型颈髓损伤治疗方面是否存在优越性。方法回顾性分析2012年1月至2016年12月收治的118例无骨折脱位型颈髓损伤患者资料，男98例，女20例；年龄18—78岁，平均50．1岁。其中2012年1月至2014年6月收治的患者根据SLIC评分指导治疗，2014年7月至2016年12月收治的患者采用ABCD分类指导治疗。对118例患者运用SLIC评分和ABCD分类重新评估，筛选出两种分型系统在指导意见上存在分歧的患者30例，也就是SLIC评分建议保守而ABCD分类建议手术的病例，依据当时实际采取的治疗方案分为保守组16例和手术组14例，比较两组患者治疗前、后日本矫形外科协会（JOA）评分改善率。结果30例患者治疗后获12～48个月（平均20个月）随访，治疗后1年有10例患者ASIA分级提高了1级，其中保守组4例，手术组6例。保守组患者JOA评分改善率（40．58％±23．02％）差于手术组（61．44％±27．06％），差异有统计学意义（Z=-2．085，P=0．037）。性别、年龄、术式与治疗结果无相关性，差异无统计学意义（P〉0．05）。手术或保守治疗与治疗效果有相关性，差异有统计学意义（r=5．000，P=0．025）。结论相比SLIC评分，ABCD分类在指导无骨折脱位型颈髓损伤的诊疗方面存在显著优势，运用ABCD分类指导该类损伤治疗可以获得更好的神经功能恢复，可以为该类损伤的诊疗提供规范化的治疗方案。

Objective To explore whether the ABCD classification has any advantage over the subaxial cervical spine injury classification （SLIC） in the treatment of cervical spinal cord injury without fracture or dislocation. Methods Included in this study were 118 patients who had been treated for cervical spinal cord injury without fracture or dislocation from January 2012 to December 2016. They were 98 men and 20 women, aged from 18 to 78 years （average, 50. 1 years）. Of them, those admitted from January 2012 to June 2014 were diagnosed and treated according to the SLIC while those admitted from July 2014 to December 2016 were diagnosed and treated by the ABCD classification. After a retrospective re-evaluation of the 118 cases was conducted using the classification other than their original one, 30 cases were identified who showed discrepancy in the guidance indicated by the classification. Conservative treatment had been suggested for them by the SLIC but surgical treatment was suggested by the ABCD classification. Actually, 16 of them had been treated conservatively and 14 surgically. The 2 groups of the 30 cases were compared in terms of preand post-operative American Spinal Injury Association （ASIA） and Japanese Orthopedic Association （JOA） scores. Results The 30 patients were followed up for 12 to 48 months （average, 20 months） . Ten of them obtained one grade ASIA improvement （4 in the conservative group and 6 in the surgical group） one year after operation. The JOA improvement rate for the conservative group （40. 58% ± 23.02% ） was significantly lower than that for the surgical group （61.44% ± 27.06% ） （ Z = - 2. 085, P = 0. 037）. Their gender, age, or operative procedure was not significantly correlated with their treatment results （ P 〉 0. 05）, but their conservative or surgical treatment was significantly correlated with their treatment results （χ2 = 5. 000, P = 0. 025）. Conclusion The ABCD classification may have an advantage over the SLIC in the treatment of cervical spinal cord injury without fracture or dislocation, because it may lead to better neural functional recovery due to the more appropriate treatment protocol it may provide than the SLIC.