69家三级医院创伤性脊髓损伤住院患者的功能改善分析

Function improvement of inpatients with traumatic spinal cord injury in 69 gradeⅢhospitals

目的分析年龄对不同损伤程度创伤性脊髓损伤(TSCI)住院患者神经功能恢复的调节作用,为制定针对性的治疗方案提供依据。方法基于中国TSCI住院患者流行病学调查的69家三级医院4404例TSCI住院患者数据,用独立样本t检验、χ^(2)检验和Wilcoxon秩和检验分析不同年龄组患者的特征差异;用logistic回归模型分析调整混杂因素前后,年龄与入院ASIA(美国脊髓损伤协会损伤分级标准)损伤分级在TSCI住院患者治疗效果中的交互作用。结果4404例TSCI住院患者中,≥65岁占20.3%。以65岁为界的年龄分组中,老年组和年轻组在入院ASIA损伤分级和性别的差异无统计学意义(P>0.05);在住院时间、损伤水平、损伤病因和受伤至手术时间的差异具有统计学意义(P<0.05)。在TSCI患者住院救治中,不同入院ASIA损伤分级患者在年龄分组上表现不同的治疗效果,其中入院ASIA C级患者在年轻组(49.5%)和老年组(37.7%)上的脊髓损伤改善差异具有统计学意义(P<0.05)。在不同损伤程度患者分年龄组的疗效差异中,调整混杂因素前后年龄与入院ASIA损伤分级的交互作用差异均无统计学意义(P>0.05),但入院ASIA B级、C级与年龄交互作用分析的P值<0.1。结论在TSCI病程早期,年龄在损伤程度谱中表现出不同的脊髓神经恢复调节作用,提示在救治过程应综合考虑年龄因素,制定有针对性的救治方案。

Objective To analyze the effect of age on the recovery of neurological function of TSCI inpatients with traumatic spinal cord injury(TSCI)at different severity,and provide evidence for the development of targeted treatment plans.Methods Based on the data of the epidemiological survey of TSCI conducted in 4404 TSCI inpatients in 69 gradeⅢhospitals in China,independent sample t-test,χ^(2) test and Wilcoxon rank sum test were used to analyze the differences in the characteristics of TSCI inpatients in different age groups.Logistic regression model was used to analyze the interaction between age and injury grade based on the criteria of American Spinal Injury Association(ASIA)at hospital admission before and after adjusting for confounding factors.Results Among 4404 TSCI inpatients,those aged≥65 years accounted for20.3%.There was no significant differences in ASIA injury grade at hospital admission and gender between age group>65years and age group<65 years(P>0.05),but there were significant differences in hospital stay,injury severity,injury etiology and interval between injury and surgical operation(P<0.05).In the hospitalized treatment,TSCI inpatients with different ASIA injury grades at hospital admission showed different treatment outcomes in different age groups.For the inpatients with ASIA grade C injury,there was significant difference in the function improvement between age group<65years(49.5%)and age group>65 years(37.7%,P<0.05).There was no significant difference in the interaction between age and ASIA injury grade at hospital admission before and after adjustment of confounding factors(P>0.05),but the P value of ASIA B,C and age interaction was<0.1.Conclusion In the early stage of TSCI,age as a potential effect moderator governing the relationship between spectrum of injury severity and TSCI therapeutic effect.It is suggested that the age of patients should be comprehensively considered and a targeted treatment plan should be formulated in the treatment process.