创伤性和非创伤性脊髓损伤:意大利的神经学和功能结局比较。

Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes.

机构信息

Spinal Cord Unit, IRCCS S Lucia Foundation, Rome, Italy.

出版信息

Spinal Cord. 2011 Mar;49(3):391-6. doi: 10.1038/sc.2010.85. Epub 2010 Jul 6.

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients.

SETTING

Spinal cord unit of a rehabilitation hospital in Italy.

PATIENTS AND METHODS

In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days).

INTERVENTIONS

Not applicable.

MEASURES

American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury.

STATISTICAL ANALYSIS

Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found.

RESULTS

Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes.

CONCLUSIONS

In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement.

摘要

研究设计

回顾性研究。

目的

比较非创伤性和创伤性脊髓损伤患者的康复结果。

设置

意大利一家康复医院的脊髓损伤病房。

患者和方法

共有 380 名患者在损伤后首次康复治疗期间入住(144 名创伤性患者和 236 名非创伤性患者;244 名男性和 136 名女性;平均年龄 46.1±19.9 岁;平均损伤至入院时间 49.6±39.8 天)。

干预措施

不适用。

测量

美国脊髓损伤协会标准;巴氏指数(BI)、Rivermead 移动指数和脊髓损伤步行指数。

统计分析

采用泊松回归模型,计算相对风险和 95%置信区间,并对以下混杂因素进行调整:年龄、性别、损伤水平和损伤程度。由于发现不同变量与年龄之间存在强烈的交互作用,因此模型按年龄分层。

结果

创伤性和非创伤性人群在年龄、损伤水平和严重程度方面存在多项显著差异。在调整这些因素后,创伤性损伤患者的入院 BI 评分明显较低,出院时 BI 评分的改善明显更好。两种人群的功能结局相似。其他结果无显著差异。

结论

在临床稳定的患者中,脊髓损伤病因似乎不会影响康复预后。入院时,创伤性患者的日常生活活动自主性较低,可能是因为这些患者经常伴有相关损伤。出院时,创伤性和非创伤性脊髓损伤患者在神经和功能改善方面取得了相似的结果。

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