Lukáš R, Barsa P, Pazour J, Šrám J
Traumatologicko-ortopedické centrum se spinální jednotkou, Krajská nemocnice Liberec, a.s.
Acta Chir Orthop Traumatol Cech. 2012;79(3):233-7.
The effect of an early surgical intervention in the traumatised spine on resolution of neurological deficit still remains a topic of professional discussions. The aim of this retrospective study was to find a correlation between the length of an injury-to-surgery interval and the development of a post-operative neurological deficit, and thus to answer the question of whether early surgical decompression and stabilization gives better chance of neurological recovery.
Medical records of consecutive surgical patients admitted between 2007 and 2010 with traumatic spinal cord injury were reviewed and the injury-to-surgery interval and post-operative development of neurological deficit at a minimum follow-up of 6 months was evaluated. The initial neurological finding and the finding at 6 months of follow-up were classified on the Frankel scale and the outcome was assessed as improved or unimproved. The patients were allocated to four subgroups according to the time that elapsed between injury and surgery, i.e., time up to 24 h, 24-72 h, 72 h -1 week, and longer than 1 week. The percentage of improved patients was calculated in each subgroup and the results were statistically evaluated using the Kruskal-Wallis test at a significance level of 0.1.
Out of the total number of 32 evaluated patients, 28 had at least partial neurological recovery. In the subgroup treated within first 24 h, improvement was found in 93 % of the patients, in the 24-72 h subgroup it was 80%, in the 72 h-1 week subgroup it was 60% and surgery later than a week after injury resulted in improvement in 42% of the patients. Based on statistical evaluation, the time between injury and surgery appeared to be a significant prognostic factor. When a paired comparison of subgroups was made, the only significant difference was found between the subgroup treated within 24 hours of injury and that operated on later than a week after injury. The other paired comparisons failed to show a significant difference due to a small number of patients; however, a tendency to better functional results was observed in all earlier- treated subgroups.
The authors are aware of few limitations of the study. Its retrospective character, a relatively small number of patients and a single institution setup may limit the interpretation. Despite this fact, the message is clear. Similar studies carried out prospectively at several institutions may, however, provide results with a higher validity.
Patients with traumatic spinal cord injury who undergo early decompression and stabilisation have a higher chance of at least partial neurological recovery.
创伤性脊柱早期手术干预对神经功能缺损恢复的影响仍是专业讨论的话题。这项回顾性研究的目的是找出受伤至手术间隔时间与术后神经功能缺损发展之间的相关性，从而回答早期手术减压和稳定是否能为神经恢复提供更好机会的问题。
回顾了2007年至2010年期间收治的连续性创伤性脊髓损伤手术患者的病历，并评估了受伤至手术间隔时间以及至少随访6个月时的术后神经功能缺损发展情况。根据Frankel分级对初始神经功能检查结果和随访6个月时的结果进行分类，并将结果评估为改善或未改善。根据受伤与手术之间的时间间隔，将患者分为四个亚组，即伤后24小时内、24 - 72小时、72小时至1周以及超过1周。计算每个亚组中病情改善患者的百分比，并使用Kruskal - Wallis检验在显著性水平为0.1时对结果进行统计学评估。
在总共32例评估患者中，28例至少有部分神经功能恢复。在伤后24小时内接受治疗的亚组中，93%的患者病情改善；在24 - 72小时亚组中为80%；在72小时至1周亚组中为60%；伤后一周后手术的患者中，42%的患者病情改善。基于统计学评估，受伤与手术之间的时间似乎是一个重要的预后因素。当对亚组进行配对比较时，仅在伤后24小时内接受治疗的亚组与伤后一周后手术的亚组之间发现了显著差异。由于患者数量较少，其他配对比较未显示出显著差异；然而，在所有早期治疗的亚组中均观察到功能结果有改善的趋势。
作者意识到该研究存在一些局限性。其回顾性特点、相对较少的患者数量以及单一机构设置可能会限制研究结果的解释。尽管如此，信息是明确的。然而，在多个机构进行的前瞻性类似研究可能会提供效度更高的结果。
接受早期减压和稳定治疗的创伤性脊髓损伤患者至少有部分神经功能恢复的机会更高。
