Kirshblum Steven, Millis Scott, McKinley William, Tulsky David
Kessler Institute for Rehabilitation, West Orange, NJ 07052, USA.
Arch Phys Med Rehabil. 2004 Nov;85(11):1811-7. doi: 10.1016/j.apmr.2004.03.015.
To present Model Spinal Cord Injury System (MSCIS) data on late neurologic recovery after 1 year after spinal cord injury (SCI).
Longitudinal study of neurologic status as determined by annual evaluations at 1 and 5 years postinjury.
MSCIS centers contributing data on people with traumatic SCI to the National Spinal Cord Injury Statistical Center database.
People with traumatic SCI (N=987) admitted to an MSCIS between 1988 and 1997 with 1- and 5-year follow-up examinations.
Not applicable.
American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, motor index scores (MIS), motor level, and neurologic level of injury (NLI), measured and compared for changes over time.
The majority of subjects (94.4%) who had a neurologically complete injury at 1 year remained complete at 5 years postinjury, with 3.5% improving to AIS grade B, and up to 1.05% each improving to AIS grades C and D. There was a statistically significant change noted for MIS. There were no significant changes for the motor level and NLI over 4 years; however, approximately 20% of subjects improved their motor level and NLI. People with complete and incomplete injuries had similar improvements in motor level, but subjects with an incomplete injury had a greater chance of improvement in NLI and MIS.
There was a small degree of neurologic recovery (between 1 and 5 y postinjury) after a traumatic SCI. Late conversion, between 1 and 5 years, from a neurologically complete to an incomplete injury occurred in 5.6% of cases, but in only up to 2.1% was there a conversion from motor complete to motor incomplete status. Limitations of this study included changes in the ASIA classification during the study and in the intra- and interrater reliability typically seen in longitudinal studies of the ASIA standards. Functional changes were not studied. Knowledge of the degree of late recovery may help in analyzing newer interventions to enhance recovery.
呈现脊髓损伤（SCI）后1年晚期神经功能恢复的脊髓损伤模型系统（MSCIS）数据。
通过损伤后1年和5年的年度评估确定神经功能状态的纵向研究。
向国家脊髓损伤统计中心数据库提供创伤性SCI患者数据的MSCIS中心。
1988年至1997年间入住MSCIS且接受了1年和5年随访检查的创伤性SCI患者（N = 987）。
不适用。
测量并比较美国脊髓损伤协会（ASIA）损伤量表（AIS）分类、运动指数评分（MIS）、运动平面和神经损伤平面（NLI）随时间的变化。
1年时神经功能完全损伤的大多数受试者（94.4%）在损伤后5年仍为完全损伤，3.5%改善至AIS B级，改善至AIS C级和D级的各高达1.05%。MIS有统计学显著变化。4年间运动平面和NLI无显著变化；然而，约20%的受试者改善了运动平面和NLI。完全损伤和不完全损伤的患者在运动平面上有相似的改善，但不完全损伤的受试者在NLI和MIS上有更大的改善机会。
创伤性SCI后（损伤后1至5年）有小程度的神经功能恢复。1至5年间，5.6%的病例发生了从神经功能完全损伤到不完全损伤的晚期转变，但从运动完全损伤到运动不完全损伤状态的转变仅高达2.1%。本研究的局限性包括研究期间ASIA分类的变化以及ASIA标准纵向研究中常见的评分者内和评分者间信度变化。未研究功能变化。了解晚期恢复程度可能有助于分析促进恢复的新干预措施。
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