Center for Spinal Cord Injury, Trauma Center Murnau, Murnau am Staffelsee, Germany.
Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
Spinal Cord. 2020 Jan;58(1):70-77. doi: 10.1038/s41393-019-0325-x. Epub 2019 Jul 16.
Retrospective matched cohort study.
Assessing the influence of surgically managed grade 3 and 4 pressure ulcers (PU) in the acute phase after spinal cord injury (SCI) on the neurological and functional outcome after 1 year.
Specialized SCI-unit within a level 1 trauma center in Murnau, Germany.
We performed a retrospective matched cohort study. For every patient with acute SCI and a PU requiring surgery, we identified matched controls within our database in a 1:3 ratio. Matching criteria were: AIS-grade (American Spinal Injury Association Impairment Scale), neurological level and age. The scores of the SCIM-III (Spinal Cord Independence Measure) and the ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury) as well as the total length of stay (LOS) at the hospital were used as outcome parameters. We applied a stratified analysis using a conditional logistic regression to test for group differences in each outcome parameter of the study.
In a 6-year period (2010-2015) 28 patients required flap surgery due to 3-4° PU in the acute phase after SCI. Of these patients, 15 had complete data sets according to the EMSCI (European Multicenter Study about Spinal Cord Injury) protocol. Patients with severe PUs during the acute SCI phase had a significantly impaired functional outcome. After 1 year the improvement of the SCIM score was significantly lower in the PU group compared to the control group (17.4 versus 30.5; p < 0.006). However, the change in AIS grade after 1 year was not significantly affected. The LOS was prolonged by a mean of 48 days in the PU group (p < 0.006).
Severe PUs requiring surgery in the acute phase after SCI impair the functional outcome and increase LOS. Preventive measures should be applied to all acute SCI patients. Patients should be transferred to specialized SCI-centers as soon as possible.
回顾性匹配队列研究。
评估脊髓损伤（SCI）后急性期手术治疗 3 级和 4 级压力性溃疡（PU）对 1 年后神经和功能结局的影响。
德国莫瑙 1 级创伤中心的专门 SCI 病房。
我们进行了一项回顾性匹配队列研究。对于每例急性 SCI 合并需要手术的 PU 患者，我们在数据库中按 1:3 的比例识别匹配对照。匹配标准为：AIS 级（美国脊髓损伤协会损伤量表）、神经水平和年龄。使用 SCIM-III（脊髓独立性测量）和 ISNCSCI（脊髓损伤国际标准分类）评分以及住院总住院时间（LOS）作为结局参数。我们应用分层分析，采用条件逻辑回归检验研究中每个结局参数的组间差异。
在 6 年期间（2010-2015 年），28 例患者因 SCI 后急性期 3-4 度 PU 需要行皮瓣手术。其中，15 例患者根据 EMSCI（欧洲多中心脊髓损伤研究）方案有完整的数据集。在急性 SCI 期间发生严重 PU 的患者功能结局明显受损。1 年后，PU 组的 SCIM 评分改善明显低于对照组（17.4 比 30.5；p<0.006）。然而，1 年后 AIS 级的变化无显著差异。PU 组的 LOS 平均延长 48 天（p<0.006）。
在 SCI 后急性期需要手术治疗的严重 PU 会损害功能结局并增加 LOS。应向所有急性 SCI 患者应用预防措施。应尽快将患者转至专门的 SCI 中心。
