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下颈椎创伤后神经功能转归的预测因素

Predictors of Neurological Outcome Following Subaxial Cervical Spine Trauma.

作者信息

Hitti Frederick L, Mcshane Brendan J, Yang Andrew I, Rinehart Cole, Albayar Ahmed, Branche Marc, Yolcu Yagiz U, Ali Zarina S, Schuster James M, Ozturk Ali K

机构信息

Neurosurgery, University of Pennsylvania, Philadelphia, USA.

出版信息

Cureus. 2019 Dec 17;11(12):e6402. doi: 10.7759/cureus.6402.

Abstract

Background The treatment of traumatic subaxial cervical spine injuries remains controversial. The American Spinal Injury Association (ASIA) impairment scale (AIS) is a widely-used metric to score neurological function after spinal cord injury (SCI). Here, we evaluated the outcomes of patients who underwent treatment of subaxial cervical spine injuries to identify predictors of neurologic function after injury and treatment. Methods We performed a retrospective logistic regression analysis to determine predictors of neurological outcome; 76 patients met the inclusion criteria and presented for a three-month follow-up. The mean age was 50.6±18.7 years old and the majority of patients were male (n=49, 64%). Results The majority of patients had stable AIS scores at three months (n=56, 74%). A subset of patients showed improvement at three months (n=16, 21%), while a small subset of patients had neurological decline at three months (n=4, 5%). In our model, increasing patient age (odds ratio [OR] 1.39, 1.10-2.61 95% confidence interval [CI], P<0.001) and a previous or current diagnosis of cancer (OR 22.4, 1.25-820 95% CI, P=0.04) significantly increased the odds of neurological decline at three months. In patients treated surgically, we found that delay in surgical treatment (>24 hours) was associated with a decreased odds of neurological improvement (OR 0.24, 0.05-0.99 95% CI, P=0.048). Cervical spine injuries are heterogeneous and difficult to manage. Conclusion We found that increasing patient age and an oncologic history were associated with neurological deterioration while a delay in surgical treatment was associated with decreased odds of improvement. These predictors of outcome may be used to guide prognosis and treatment decisions.

摘要

背景

创伤性下颈椎损伤的治疗仍存在争议。美国脊髓损伤协会(ASIA)损伤量表(AIS)是一种广泛用于评估脊髓损伤(SCI)后神经功能的指标。在此,我们评估了接受下颈椎损伤治疗的患者的预后,以确定损伤和治疗后神经功能的预测因素。方法:我们进行了一项回顾性逻辑回归分析,以确定神经功能预后的预测因素;76例患者符合纳入标准,并进行了为期三个月的随访。平均年龄为50.6±18.7岁,大多数患者为男性(n = 49,64%)。结果:大多数患者在三个月时AIS评分稳定(n = 56,74%)。一部分患者在三个月时有所改善(n = 16,21%),而一小部分患者在三个月时神经功能下降(n = 4,5%)。在我们的模型中,患者年龄增加(优势比[OR]1.39,95%置信区间[CI]为1.10 - 2.61,P < 0.001)以及既往或当前患有癌症(OR 22.4,95% CI为1.25 - 820,P = 0.04)显著增加了三个月时神经功能下降的几率。在接受手术治疗的患者中,我们发现手术治疗延迟(>24小时)与神经功能改善几率降低相关(OR 0.24,95% CI为0.05 - 0.99,P = 0.048)。颈椎损伤具有异质性且难以处理。结论:我们发现患者年龄增加和肿瘤病史与神经功能恶化相关,而手术治疗延迟与改善几率降低相关。这些预后预测因素可用于指导预后和治疗决策。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe9c/6964960/62c4fbc23506/cureus-0011-00000006402-i01.jpg

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