AIS C级和D级急性创伤性颈髓损伤患者不同手术时机的疗效对比及影响因素分析

Comparison of curative effect and influencing factors of different surgical timings in patients with AIS grade C and grade D acute traumatic cervical spinal cord injury

目的对比不同手术时机下美国脊柱损伤协会损伤量表(AIS)评为C级和D级的急性创伤性颈髓损伤患者疗效差异,并分析相关影响因素。方法回顾性分析我院2013-2021年收治急性创伤性颈髓损伤(traumatic cervical spinal cord injury,TCSCI)的病例资料,选取AIS评为C级和D级且末次随访时间>6个月者,根据不同手术时机分为三组,A组<48 h,B组≥48 h且<1周,C组≥1周。收集相关病例资料包括:性别、年龄、损伤原因、损伤平面、AIS等级、入院时美国脊髓损伤协会运动评分(AMS)、术后6个月AMS、术后AMS改善分值等。对比分析三组患者术后末次随访AMS较术前改善的情况,并回归分析影响手术时机选择的相关因素。结果共纳入79例患者,入院时AIS分级为C级28例,D级51例,男60例,女19例,平均年龄(49.87±11.18)岁,高处坠落伤11例,机动车事故伤33例,重物砸伤8例,平地摔伤27例,损伤平面为C1⁃460例,C5⁃819例。A组21例,B组31例,C组27例,三组之间在性别、年龄、外伤原因、AIS分级、术前和术后AMS评分、损伤平面差异均无统计学意义,末次随访AMS评分A组与B组、C组比较差异有统计学意义(P=0.04),B、C组之间比较差异无统计学意义(P>0.05)。有序多分类logistic分析显示,影响手术时机选择因素的相关程度:早期呼吸道并发症(OR=2.89)、伴合并伤(OR=4.39)、伴内科基础病(OR=6.25)、白细胞数量≥10×109/L(OR=5.50)。结论对于AIS C级和D级急性创伤性颈髓损伤患者48 h内手术疗效明显更优,伴内科基础疾病是导致这类患者手术时机延迟的最主要因素。

Objective To compare the efficacy of acute traumatic cervical spinal cord injury patients with AIS grade C and D under different surgical timing,and to analyze the related factors affecting the surgical timing.Methods Retrospective analysis was performed on the patients with acute traumatic cervical spinal cord injury(TCSCI)in our hospital from March 2013 to April 2021,who rated as American Spinal Injury Association Injury Scale(AIS)grade C and D.The patients who had been followed up for more than 6 months in the last outpatient clinic were divided into three groups based on operation timing:group A less than 48 hours,group B more than 48 hours and less than 1 week,and group C more than 1 week.Collect the case data in the three groups after admission,including:gender,age,injury cause,injury plane,AIS grade,AMS score(ASIA Motor Score)at admission,AMS at 6 months after surgery,and improvemental score of AMS after surgery.Compare and contrast the three groups′AMS improvement scores following surgery.Regression analysis was performed on related factors affecting the surgical timing.Results A total of 79 patients were enrolled,including 28 patients with AIS grade C and 51 patients with AIS grade D at admission as well as 60 males and 19 females with an average age of(49.87±11.18)years old.There were 11 high fall injuries,33 motor vehicle collisions,8 heavy bruises,and 27 cases of falling down.The damage plane with C1⁃4 and C5⁃8 was 60 and 19 cases respectively.Group A had 21 cases,Group B had 31 cases,and Group C had 27 cases.There were no significant differences in gender,age,the causes of trauma,AIS grade,preoperative and postoperative AMS,and injury plane among the three groups.At the last postoperative follow⁃up,there were significant differences in AMS scores between groups A,B,and C(P=0.04).There was no statistically significant difference between groups B and C.Ordered multiple Logistic analysis showed that the factors that prolonged the timing of surgery included:early respiratory complications(OR=2.89),associ⁃ated injury(OR=4.39),basic diseases of internal medicine(OR=6.25),the number of white blood cells in labo⁃ratory was more than 10×109/L(OR=5.50).Conclusions Acute traumatic cervical spinal cord injury patients with AIS grades C and D fare much better within 48 hours of surgery.The most significant factor contributing to the operation time delay was basic diseases of internal medicine.