急性脊髓缺血与外伤性脊髓损伤的结局是否不同？93 例截瘫患者队列的神经和功能结局的横断面分析。

Is the outcome in acute spinal cord ischaemia different from that in traumatic spinal cord injury? A cross-sectional analysis of the neurological and functional outcome in a cohort of 93 paraplegics.

机构信息

Spine Unit, Department of Orthopedic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

出版信息

Spinal Cord. 2011 Feb;49(2):307-12. doi: 10.1038/sc.2010.114. Epub 2010 Aug 31.

DOI:10.1038/sc.2010.114

PMID:20805834

Abstract

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

To compare the neurological outcome between paraplegic patients with acute spinal cord ischaemia syndrome (ASCIS) or traumatic spinal cord injury (tSCI) and to investigate the influence of SCI aetiology on the total Spinal Cord Independence Measure (SCIM)-II score.

SETTING

Level 1 trauma centre.

METHODS

Initial (0-40 days) and chronic-phase (6-12 months) American Spinal Injury Association (ASIA) sensory scores, lower extremity motor score (LEMS) and chronic-phase total SCIM-II scores were analysed. Differences between ASCIS and tSCI patients were calculated using Student's t-tests and Wilcoxon signed-rank tests. To assess which variables give rise to the prediction of total SCIM-II score, a multiple linear regression analysis was used. These predictor variables included complete (ASIA impairment scale A) or incomplete SCI (AIS B, C, and D), aetiology, age and gender.

RESULTS

Out of 93 included patients, 20 ASCIS and 73 tSCI patients were identified. In the complete SCI group, the initial pinprick scores were higher (P<0.05) in ASCIS patients compared with tSCI patients, 37.9 (95% Confidence Interval (CI), 23.3-52.5) and 27.3 (95% CI, 24.1-30.4), respectively. No other relevant differences in neurological outcome were identified between ASCIS and tSCI patients; however, the total SCIM-II scores were higher (P<0.05) in tSCI patients after 12 months. Using the linear regression analysis, we were able to predict 31.4% of the variability. The aetiology was not significant in this model.

CONCLUSION

The neurological outcome was independent of the diagnosis ASCIS or tSCI. Furthermore, the diagnosis ASCIS or tSCI was not a significant predictor for total SCIM II scores after 12 months.

SPONSORSHIP

This study was granted by the 'Internationale Stiftung für Forschung in Paraplegie' (IFP), Zürich, Switzerland.

摘要

研究设计

回顾性队列研究。

目的

比较急性脊髓缺血综合征（ASCIS）或创伤性脊髓损伤（tSCI）截瘫患者的神经功能预后，并探讨脊髓损伤病因对脊髓独立性测量（SCIM）- II 总评分的影响。

地点

1 级创伤中心。

方法

分析初始（0-40 天）和慢性期（6-12 个月）美国脊髓损伤协会（ASIA）感觉评分、下肢运动评分（LEMS）和慢性期总 SCIM-II 评分。使用学生 t 检验和 Wilcoxon 符号秩检验计算 ASCIS 和 tSCI 患者之间的差异。为了评估哪些变量导致总 SCIM-II 评分的预测，使用多元线性回归分析。这些预测变量包括完全性（ASIA 损伤量表 A）或不完全性脊髓损伤（AIS B、C 和 D）、病因、年龄和性别。

结果

在 93 名纳入的患者中，确定了 20 名 ASCIS 和 73 名 tSCI 患者。在完全性脊髓损伤组中，ASCIS 患者的初始刺痛评分较高（P<0.05），分别为 37.9（95%置信区间（CI），23.3-52.5）和 27.3（95%CI，24.1-30.4）。ASCIS 和 tSCI 患者之间在神经功能预后方面没有发现其他相关差异；然而，12 个月后 tSCI 患者的总 SCIM-II 评分更高（P<0.05）。使用线性回归分析，我们能够预测 31.4%的可变性。在该模型中，病因没有显著性。