Zhang Pei-Xun, Xue Feng, Wang Jing, Zhang Hong-Bo, Xu Hai-Lin, Jiang Bao-Guo
Department of Trauma and Orthopedics, People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2009 Mar 15;47(6):461-4.
To rudiment analyze the different intervention factors affecting the spinal cord injury functional recovery initially through prospective study project.
Designed prospective study project without clinical treatment intervention and admitted 62 spinal cord injury cases into observation group from Dec 2006 to Dec 2007. The internalized standard included acute spinal cord injury within 1 week, aged from 18 to 65 years old without sexuality difference and diagnosed as type A injury: total spinal cord injury or type B injury: non-total spinal cord injury (without movement function below the injury plane) according to clinical physical examination and combined MRI or CT examination. All the 62 cases were followed up. The spinal cord function were estimated at the time of arriving hospital, 1, 3, 6 months after injury during the following up time according to the American Spine Injury Association standard (Revised at 2000) and functional independence measure (FIM) score. The intervention factors affecting the spinal cord injury functional recovery were analyzed.
Among the 62 cases, male 60 cases and female 2 cases, aged from 18 to 41 years old, mean age 24 years old, 29 cases can be classified into type A injury and 33 cases can be classified into type B injury. There was no significant difference (Index including sense ASIA, motor ASIA and FIM) between operation group and non-operation group, namely conservatively composite treatment at all observation point in all type A injury cases (P > 0.05). There was significant difference (Index including sense ASIA, motor ASIA and FIM) between operation group and non-operation group at all observation point in all type B injury cases (P < 0.05); And there was significant difference (Index including sense ASIA, motor ASIA and FIM) between operated in 8 hours (< or = 8 h) group and beyond 8 hours (> 8 h) group at all observation point in all type B operated cases (P < 0.05).
Operation and operation time were of no significant value for type A injury (total spinal cord injury), but considering the nursing convenience and the need for spinal stabilities, operation decompression and internal fixation can be chosen; Operation decompression should be performed as soon as quickly for type B injury (non-total spinal cord injury) in order to get better functional recovery.
通过前瞻性研究项目初步对影响脊髓损伤功能恢复的不同干预因素进行初步分析。
设计无临床治疗干预的前瞻性研究项目，于2006年12月至2007年12月纳入62例脊髓损伤病例作为观察组。纳入标准包括伤后1周内的急性脊髓损伤，年龄18至65岁，无性别差异，根据临床体格检查及MRI或CT检查综合诊断为A类损伤：完全性脊髓损伤或B类损伤：非完全性脊髓损伤（损伤平面以下无运动功能）。对62例患者均进行随访。在随访期间，根据美国脊髓损伤协会标准（2000年修订）和功能独立性测量（FIM）评分，于入院时、伤后1、3、6个月评估脊髓功能。分析影响脊髓损伤功能恢复的干预因素。
62例中，男性60例，女性2例，年龄18至41岁，平均年龄24岁，A类损伤29例，B类损伤33例。所有A类损伤病例在所有观察点，手术组与非手术组之间无显著差异（指标包括感觉ASIA、运动ASIA和FIM）（P>0.05）。所有B类损伤病例在所有观察点，手术组与非手术组之间有显著差异（指标包括感觉ASIA、运动ASIA和FIM）（P<0.05）；所有B类手术病例在所有观察点，8小时内（≤8小时）手术组与8小时后（>8小时）手术组之间有显著差异（指标包括感觉ASIA、运动ASIA和FIM）（P<0.05）。
手术及手术时机对A类损伤（完全性脊髓损伤）无显著意义，但考虑护理便利性及脊柱稳定性需求，可选择手术减压及内固定；对于B类损伤（非完全性脊髓损伤）应尽早进行手术减压，以获得更好的功能恢复。
