Lee Dong-Yeong, Park Young-Jin, Song Sang-Youn, Hwang Sun-Chul, Kim Kun-Tae, Kim Dong-Hee
Department of Orthopaedic Surgery, Armed Forces Daegu Hospital, Gyeongsan, Korea.
Department of Orthopaedic Surgery and Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.
Clin Orthop Surg. 2018 Dec;10(4):448-454. doi: 10.4055/cios.2018.10.4.448. Epub 2018 Nov 21.
Traumatic spinal cord injury (SCI) is a tragic event that has a major impact on individuals and society as well as the healthcare system. The purpose of this study was to investigate the strength of association between surgical treatment timing and neurological improvement.
Fifty-six patients with neurological impairment due to traumatic SCI were included in this study. From January 2013 to June 2017, all their medical records were reviewed. Initially, to identify the factors affecting the recovery of neurological deficit after an acute SCI, we performed univariate logistic regression analyses for various variables. Then, we performed a multivariate logistic regression analysis for variables that showed a -value of < 0.2 in the univariate analyses. The Hosmer-Lemeshow test was used to determine the goodness of fit for the multivariate logistic regression model.
In the univariate analysis on the strength of associations between various factors and neurological improvement, the following factors had a -value of < 0.2: surgical timing (early, < 8 hours; late, 8-24 hours; = 0.033), completeness of SCI (complete/incomplete; = 0.033), and smoking ( = 0.095). In the multivariate analysis, only two variables were significant: surgical timing (odds ratio [OR], 0.128; = 0.004) and completeness of SCI (OR, 9.611; = 0.009).
Early surgical decompression within 8 hours after traumatic SCI appeared to improve neurological recovery. Furthermore, incomplete SCI was more closely related to favorable neurological improvement than complete SCI. Therefore, we recommend early decompression as an effective treatment for traumatic SCI.
创伤性脊髓损伤(SCI)是一个悲剧性事件,对个人、社会以及医疗保健系统都有重大影响。本研究的目的是调查手术治疗时机与神经功能改善之间的关联强度。
本研究纳入了56例因创伤性SCI导致神经功能障碍的患者。回顾了他们从2013年1月至2017年6月的所有病历。最初,为了确定影响急性SCI后神经功能缺损恢复的因素,我们对各种变量进行了单因素逻辑回归分析。然后,我们对在单因素分析中显示P值<0.2的变量进行了多因素逻辑回归分析。使用Hosmer-Lemeshow检验来确定多因素逻辑回归模型的拟合优度。
在对各种因素与神经功能改善之间关联强度的单因素分析中,以下因素的P值<0.2:手术时机(早期,<8小时;晚期,8 - 24小时;P = 0.033)、SCI的完整性(完全性/不完全性;P = 0.033)和吸烟(P = 0.095)。在多因素分析中,只有两个变量具有显著性:手术时机(比值比[OR],0.128;P = 0.004)和SCI的完整性(OR,9.611;P = 0.009)。
创伤性SCI后8小时内进行早期手术减压似乎可改善神经功能恢复。此外,与完全性SCI相比,不完全性SCI与更好的神经功能改善更密切相关。因此,我们建议早期减压作为创伤性SCI的一种有效治疗方法。