脊髓血管病的临床特点及预后分析

Clinical characteristics and prognosis analysis of spinal cord vascular disease

目的总结脊髓血管病临床特点,分析影响预后的相关因素。方法搜集1980年1月1日至2017年12月31日国内外期刊公开发表病例报告和苏州大学附属第二医院收治的2009年1月1日至2017年12月31日脊髓血管病例人口学信息及临床资料。研究不同病因、不同部位脊髓血管病的差异性以及影响预后的因素。结果(1)脊髓梗死组患者平均年龄明显大于脊髓出血组患者平均年龄;脊髓出血组患者入院时日本骨科协会评估治疗分数(JOA评分)明显高于脊髓梗死组;脊髓梗死组高血压、糖尿病的发病率(18.48%,8.70%)明显高于脊髓出血组高血压、糖尿病的发病率(6.67%,1.11%)(均P<0.05)。(2)胸髓的发病率(48.35%)最高;颈髓血管病的入院JOA评分最低,为(6.67±4.47)分(P<0.05)。(3)尚未发现影响脊髓梗死预后的相关因素,脊髓出血的致残率与入院时JOA评分有关(B=-0.101);脊髓出血的死亡率与高血压及病变部位有关(B=1.508;B=-0.556)(1=颈髓;2=胸髓;3=腰骶髓)(P<0.05)。(4)出院3个月随访,脊髓梗死相对脊髓出血而言,中度残疾所占比例高,轻度残疾和重度残疾所占比例少。结论脊髓血管病最常发生于胸段,累及颈髓时症状最重。脊髓出血较脊髓梗死的患者群更趋年轻化,而梗死的近期预后要优于出血。

Objective To summarize the clinical features of spinal cord vascular disease and to analyze the prognostic factors.Methods The published case reports in domestic and foreign journals from 1980.01.01 to 2017.12.31 and clinical data of spinal cord vascular disease treated in Second Affiliated Hospital of Soochow University from 2009.01.01 to 2017.12.31 were collected.To study the difference of different etiology and different parts of spinal cord vascular disease and its prognostic factors.Results(1)The mean age of the patients with spinal cord infarction was significantly older than that of the patients with spinal cord hemorrhage;the Assessment of treatment scores by the Japanese Orthopaedic Association(JOA)score of patients with spinal cord hemorrhage was significantly higher than that of patients with spinal cord infarction;the incidence of hypertension and diabetes in spinal cord infarction group(18.48%,8.70%)were significantly higher than those in spinal cord hemorrhage group(6.67%,1.11%)(all P<0.05).(2)The incidence of thoracic spinal cord was the highest(48.35%).Admission to JOA of cervical myelopathy was the lowest(6.67±4.47)(P<0.05).(3)No factors related to the prognosis of spinal cord infarction had been found.The disability rate of spinal cord hemorrhage was related to the JOA score at admission(B=-0.101),and the mortality of spinal cord hemorrhage was related to hypertension and location of lesion(B=1.508;B=-0.556)(1=cervical spinal cord;2=thoracic spinal cord;3=lumbosacral spinal cord)(P<0.05).(4)Follow up in three months later,compared with spinal cord hemorrhage,the proportion of moderate disability was higher than that in spinal cord infarction,and the proportion of mild disability and severe disability was less.Conclusions Spinal vascular disease occurs most frequently in the thoracic segment,the cervical spinal vascular disease is the most serious.The patient population of spinal cord hemorrhage is younger than that in spinal cord infarction,the short-term prognosis of spinal cord infarction is better than that of spinal cord hemorrhage.