脊髓损伤并发肌痉挛的相关影响因素分析

Analysis of related influencing factors of spinal cord injury complicated with spasticity

目的 明确肌痉挛的流行病学特征、分析脊髓损伤并发肌痉挛的保护性或危险性因素。方法 回顾性分析自2019-01—2022-12于贵州医科大学附属医院康复医学科住院治疗的183例脊髓损伤患者,根据脊髓损伤有无合并肌痉挛分为痉挛组和非痉挛组,分别对两组患者的年龄、性别、病程、脊髓损伤节段、损伤分级,以及是否合并贫血、低蛋白血症、神经病理性疼痛、下肢深静脉血栓形成等数据进行分析,进一步分析脊髓损伤后肌痉挛的类型、发生特点、影响因素等特征。结果 痉挛组(n=47)和非痉挛组(n=136)的损伤节段、病程差异有统计学意义(P<0.05),但在性别、年龄、ASIA分级方面差异无统计学意义(P>0.05)。两组合并压疮情况差异有统计学意义(P<0.05),在合并神经病理性疼痛、下肢深静脉血栓形成、贫血、低蛋白血症、D-二聚体升高、尿路感染、肾积水方面差异无统计学意义(P>0.05)。Logistic回归分析结果显示损伤节段、病程、压疮均为脊髓损伤合并肌痉挛的独立影响因素,其中病程较长及合并压疮为独立危险因素(OR>1),低损伤节段为保护因素(OR<1)。结论 病程、损伤节段、压疮均是脊髓损伤患者合并肌痉挛的独立影响因素,其中病程延长及合并压疮是独立危险因素,低损伤节段为保护因素。

Objective To clarify the epidemiological characteristics of spasticity and analyze the protective or risk factors of spinal cord injury complicated with spasticity.Methods A retrospective analysis was performed on 183 patients with spinal cord injury who were hospitalized in the Department of Rehabilitation Medicine,Affiliated Hospital of Guizhou Medical Univer-sity from January 2019 to December 2022.Patients with spinal cord injury were divided into spasticity group and non-spasticity group according to whether they were complicated with spasticity or not.The data of age,gender,course of disease,spinal cord injury segment and injury grade,as well as whether they were complicated with anemia,hypoproteinemia,neuropathic pain and deep venous thrombosis of lower limbs were analyzed respectively.The types,characteristics and influencing factors of spastic-ity after spinal cord injury were further analyzed.Results There were statistically significant differences in injury segment and disease course between spasticity group(n=47)and non-spasticity group(n=136)(P<0.05),but no statistically significant differ-ences in gender,age and ASIA grade(P>0.05).There were statistically significant differences between the two groups in the combination of pressure ulcer(P<0.05),but no statistically significant differences in the combination of neuropathic pain,lower extremity deep vein thrombosis,anemia,hypoproteinemia,D-dimer elevation,urinary tract infection and hydronephrosis(P>0.05).Logistic regression analysis showed that injured segment,disease course and pressure ulcer were independent factors of spinal cord injury combined with spasticity,in which long disease course and pressure ulcer were independent risk factors(OR>1),and low injured segment was a protective factor(OR<1).Conclusion Disease course,injured segment and pressure ulcer are independent factors of spasm in patients with spinal cord injury.Prolonged disease course and pressure ulcers are indepen-dent risk factors while low injured segment is a protective factor.