Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2019 Sep 9;14(9):e0222134. doi: 10.1371/journal.pone.0222134. eCollection 2019.
OBJECTIVES: Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyper-reflexia, focal weakness, and sensory impairment. DCM can cause progressive loss of manual dexterity, reduced upper limb (UL) function and disability. The purpose of this study was to define relationships between impairment and disability of the UL and determine the impact of duration of symptoms on disease severity. DESIGN: An observational cross-sectional study quantifying disease severity, UL impairment and disability at time of diagnosis was conducted. A second observational longitudinal cohort was studied at the time of diagnosis and 1 year later. SETTING: Toronto Western Hospital, Spine Program. SUBJECTS: The cross sectional study included 140 study subjects diagnosed with mild, moderate or severe DCM. For the longitudinal study, 61 study subjects with mild DCM were enrolled and split into two groups, one group with less than 12 months of symptom duration and more than 12 months. MAIN MEASURES: Modified Japanese Orthopaedic Assessment (mJOA); Graded Redefined Assessment of Sensation, Strength and Prehension (GRASSP); Quick Disability of the Arm, Shoulder and Hand (QuickDASH). RESULTS: Pearson correlation coefficients between GRASSP and QuickDASH revealed significant relationships between strength, sensation and dexterity for all patients to varying degrees. The covariate (mJOA) was significantly related to QuickDASH, indicating duration of symptoms has an important effect on UL disability in the mild severity group. CONCLUSIONS: Strength, sensation and dexterity play a defining role in disability of the UL across all severities of DCM and are discriminant measures. Duration of symptoms has a significant impact on self-perceived disability, where a longer duration in mild patients results in diminished disability, suggesting adaptation. Duration of symptoms is an important factor to consider in the treatment plan for patients with mild disease.
目的：退行性颈脊髓病（DCM）涉及脊髓压迫，导致神经功能下降。DCM 的神经损伤是多变的，可能涉及复杂的上肢功能障碍，包括手的灵巧度丧失、反射亢进、局灶性无力和感觉障碍。DCM 可导致手的灵巧度进行性丧失、上肢（UL）功能和活动能力下降。本研究的目的是确定 UL 损伤和残疾与疾病严重程度之间的关系，并确定症状持续时间对疾病严重程度的影响。
设计：本研究采用观察性横断面研究，对诊断时的疾病严重程度、UL 损伤和残疾进行了量化。对第二个观察性纵向队列在诊断时和 1 年后进行了研究。
地点：多伦多西部医院，脊柱项目。
受试者：横断面研究包括 140 名被诊断为轻度、中度或重度 DCM 的研究对象。对于纵向研究，招募了 61 名轻度 DCM 研究对象，并将其分为两组，一组症状持续时间少于 12 个月，另一组持续时间超过 12 个月。
主要测量指标：改良日本骨科评估量表（mJOA）；重新定义的感觉、力量和抓握分级评估（GRASSP）；手臂、肩部和手部快速残疾（QuickDASH）。
结果：GRASSP 与 QuickDASH 之间的 Pearson 相关系数显示，所有患者的力量、感觉和灵巧度之间存在显著关系，程度不同。协变量（mJOA）与 QuickDASH 显著相关，表明在轻度严重程度组，症状持续时间对 UL 残疾有重要影响。
结论：在所有 DCM 严重程度中，力量、感觉和灵巧度在 UL 残疾中起着决定性作用，是有区别的测量指标。症状持续时间对手部残疾有显著影响，轻度患者的症状持续时间较长，残疾程度降低，提示适应性。症状持续时间是治疗轻度疾病患者的重要考虑因素。
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