Pollard Matthew E, Apple David F
Department of Orthopaedic Surgery, Atlanta Medical Center, Atlanta, Georgia, USA.
Spine (Phila Pa 1976). 2003 Jan 1;28(1):33-9. doi: 10.1097/00007632-200301010-00009.
Retrospective review of 412 patients with traumatic, incomplete, cervical spinal cord injuries, and an average follow-up period of 2 years.
To determine what patient characteristics, injury variables, and management strategies are associated with improved neurologic outcomes. In particular, the effects of intravenous steroids (NASCIS II protocol), early definitive surgery (<24 hours after injury), early anterior decompression for burst fractures or disc herniations (<24 hours after injury), and surgical decompression for stenosis without fracture were assessed.
Controversy surrounds the pharmacologic and surgical management of patients with spinal cord injuries.
Neurologic data were collected retrospectively and classified using American Spinal Injury Association guidelines. This information was recorded at the time of injury, on admission to rehabilitation, on discharge from rehabilitation, and at 1, 2, and final year of follow-up evaluation. Outcome measures included change in motor score, change in sensory score, final motor score, and final sensory score. The SPSS v10.0.7 statistical software package was used for data analysis.
Neurologic recovery was not related to the following factors: gender, race, type of fracture, or mechanism of injury. Neurologic recovery also was not related to the following interventions: high-dose methylprednisolone administration, early definitive surgery, early anterior decompression for burst fractures or disc herniations, or decompression of stenotic canals without fracture. Improved neurologic outcomes were, however, noted in younger patients ( = 0.002), and those with either a central cord or Brown-Sequard syndrome ( = 0.019).
The most important prognostic variable relating to neurologic recovery in a patient with a spinal cord injury is the completeness of the lesion. When an incomplete cervical spinal cord lesion exists, younger patients and those with either a central cord or Brown-Sequard syndrome have a more favorable prognosis for recovery. In this study, no evidence was found to support high-dose steroid administration, routine early surgical intervention, or surgical decompression in stenotic patients without fracture.
对412例创伤性、不完全性颈脊髓损伤患者进行回顾性研究，平均随访期为2年。
确定哪些患者特征、损伤变量和治疗策略与改善神经功能结局相关。特别评估了静脉注射类固醇（美国国立急性脊髓损伤研究II方案）、早期确定性手术（伤后<24小时）、爆裂骨折或椎间盘突出症的早期前路减压（伤后<24小时）以及无骨折的狭窄性椎管手术减压的效果。
脊髓损伤患者的药物和手术治疗存在争议。
回顾性收集神经功能数据，并根据美国脊髓损伤协会指南进行分类。这些信息在受伤时、康复入院时、康复出院时以及随访评估的第1年、第2年和最后一年记录。结局指标包括运动评分变化、感觉评分变化、最终运动评分和最终感觉评分。使用SPSS v10.0.7统计软件包进行数据分析。
神经功能恢复与以下因素无关：性别、种族、骨折类型或损伤机制。神经功能恢复也与以下干预措施无关：大剂量甲基强的松龙给药、早期确定性手术、爆裂骨折或椎间盘突出症的早期前路减压或无骨折的狭窄性椎管减压。然而，年轻患者（P = 0.002）以及患有中央脊髓或布朗-塞卡尔综合征的患者（P = 0.019）的神经功能结局有所改善。
与脊髓损伤患者神经功能恢复相关的最重要预后变量是损伤的完整性。当存在不完全性颈脊髓损伤时，年轻患者以及患有中央脊髓或布朗-塞卡尔综合征的患者恢复预后更佳。在本研究中，未发现支持大剂量类固醇给药、常规早期手术干预或无骨折狭窄患者手术减压的证据。
