脊髓锐器伤患者中长期随访研究

Middle and long term functional prognosis follow-up in patients with spinal cord stab injury

目的:探讨脊髓锐器伤患者中长期神经功能恢复特点,为临床康复工作提供参考。方法:回顾性分析中国康复研究中心北京博爱医院2002年1月～2016年12月收治的脊髓锐器伤患者61例,其中男49例,女12例,受伤年龄28.9±11.7岁(8～53岁)。颈脊髓损伤15例,胸脊髓损伤39例,腰脊髓损伤7例,均进行了无差别的全面系统的康复治疗。平均随访时间8.6±5.4年(2～30年)。通过美国脊髓损伤协会(American Spinal CordInjury Association,ASIA)评分标准评估其伤后1个月内、2年以上神经功能恢复情况。按照运动与感觉损伤完全性与否评估伤后1个月和2年以上的损伤程度分级(ASIA impairment scale,AIS),统计各分级患者例数;并且评估伤后1个月、3个月、6个月、1年、2年以上的运动评分(ASIA motor score,AMS)、轻触觉(light touch,LT)、针刺觉(pin prick,PP),比较其与前一次随访数据的差异。同时收集患者随访期内脊髓MRI资料,观察其是否出现脊髓空洞。结果:各损伤程度AIS分级内脊髓锐器伤患者例数为,伤后1个月内A级21例、B级16例、C级7例、D级17例,受伤2年后A级16例、B级9例、C级11例、D级24例、E级1例。伤后1个月AMS、LT、PP评分分别为57.6±22.5、69.9±25.2、68.0±25.3;3个月AMS、LT、PP分数分别为60.8±23.1,71.5±25.3,70.0±25.1;6个月AMS、LT、PP分数分别为68.3±23.2、74.9±24.9、72.9±24.7;1年AMS、LT、PP分数分别为69.6±23.2、75.3±25.1、73.2±24.8;2年后分数AMS、LT、PP分别为67.9±23.4、73.7±26.1、71.7±26.2。患者受伤2年后与伤后1个月内AIS分级无统计学差异(P>0.05);伤后前6个月AMS、LT、PP改变有统计学差异(P<0.05),1年后与6个月时ASIA评分无统计学差异(P>0.05),2年后与1年时ASIA评分无统计学差异(P>0.05)。随访到完整MRI资料19例,其中6例出现脊髓空洞,脊髓空洞发生率为31.58%(6/19)。发现脊髓空洞的时间为2个月～10年。本组未发现死亡病例。结论:脊髓锐器伤患者神经功能提高多发生在伤后半年内,随时间延长神经功能各项指标改善趋于停滞,部分患者出现脊髓空洞改变。

Objectives:To investigate the middle and long term prognosis of patients with spinal cord stab injury,and to provide evidence for clinical and rehabilitation practice.Methods:From January 2002 to December 2016,a total of 61 patients with spinal cord stab injury in China Rehabilitation Research Center were enrolled with an average age of 28.9±11.7(8-53)years old.15 were with cervical spinal cord injury,39 with thoracic and 7 with lumbosacral spinal cord.All received comprehensive rehabilitation.The follow-up time was 8.6±5.4 years(2-30 years)in average.The international standards published by American Spinal Cord Injury Association(ASIA)were used to evaluate the neurological function of patients at 1 month,3 months,6 months,1 year and more than 2 years after stab injury.The ASIA standards included ASIA impairment scale(AIS),ASIA motor score(AMS),light touch(LT)as well as pin prick(PP).Number of patients in different AIS grades at more than 2 years and 1 month was compared by usingχ2 test.AMS,LT,PP were divided into 5 groups according to the different follow-up time and t-test was used.Magnetic resonance imaging(MRI)data were collected to identify syringomyelia.Results:Number of patients in different AIS grades at 1 month was 21 in grade A,16 in grade B,7 in grade C while 17 in grade D;AIS score at more than 2 years was 16 in grade A,9 in grade B,11 in grade C,24 in grade D while 1 in grade E.AMS,LT,PP scores at 1 month were 57.6±22.5,69.9±25.2,68.0±25.3;60.8±23.1,71.5±25.3,70.0±25.1 at 3 months;68.3±23.2,74.9±24.9,72.9±24.7 at 6 months;1 year were 69.6±23.2,75.3±25.1,73.2±24.8;67.9±23.4,73.7±26.1,71.7±26.2 at more than 2 years.There was no statistic difference(P>0.05)of patients number in different AIS grades at 1 month and at more than 2 years;while there was statistic difference(P<0.05)in group 1 month vs 3 months and group 3 months vs 6 months in AMS,LT and PP.There was no statistic difference(P>0.05)in group 6 months vs 1 year and group 1 year vs 2 years in AMS,LT and PP.The occurrence rate of syringomyelia after spinal cord stab injury was 31.58%(6/19),which was discovered from 2 months to 10 years after injury.No death was discovered during follow-up.Conclusions:The improvement of neurological function in patients with spinal cord stab injury mostly occurred within 6 months after injury,and the neurological function improvement tends to be stable as time goes by,while some patients showed syringomyelia.