Bushkov F A, Razumov A N, Sichinava N V, Romanovskaya E V, Usanova E V
Rehabilitation center «Overcoming», Moscow, Russia.
Moscow center for research and practice in medical, rehabilitation, restorative and sports medicine, Moscow, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2020;97(5):22-30. doi: 10.17116/kurort20209705122.
Purpose of the study was to investigate clinical predictors of functional independence in patients with cervical tetraplegia at different periods after a spinal cord injury (SCI).
190 patients (151 men and 39 women) with an SCI from 3 months to 6 years old were included in a retrospective study. The average age was 27 years. The examination was carried out using the international standard for neurological classification of spinal cord injury (ASIA) with the definition of motor score ASIA for the upper extremity (ASIA ), neurological (NL) and motor levels (ML), and the completeness of spinal cord injury (AIS). Functional assessment was performed using the FIM motor subscale. The study of neuromuscular conduction of the median nerves - according to stimulation electroneuromyography (SENMG). The degree of functional independence was assessed as a severe disability with FIM less than 42 points, mild and moderate - FIM 42 points or more.
Using logistic regression analysis, it was found that in the first 6 months after SCI, the main predictors are ASIA (AUC=0.84; =3.32; =0.06) and NL (AUC=0.80; =2.96; =0.09). When observed in the first 12 months, ASIA (AUC=0.86) remains the leading predictor. Moreover, pronounced functional limitations can be predicted using predictors of ASIA in 84.4% and completeness of injury (AIS) in 81.2% of cases, moderate and mild limitations - ASIA in 81.4%, NL in 86.0% and functional tenodesis (FT) in 100% of cases. In the long-term period (more than 12 months), the exceptional predictive power of the predictor ASIA (AUC=0.92) is noted both in the prediction of severe (82.5%) cases and moderate and mild functional disorders (91.8% of cases). In addition, in the SCI long-term period, the predictor AIS plays a significant role in severe disorders (in 82.5% of cases), and NL (88.2%) and FT (100%) - in moderate and mild disorders. The boundaries between functional groups according to functional independence in groups of 12 months and more than 12 months after SMT are presented: ASIA 22.4 and 22.6 points, ML more than 6.5 and the presence of FT with a ML of more than 5.6, respectively. At the same time, the results of SENMG showed low predictive significance.
Motor score ASIA is a leading predictor in all periods after SCI, while completeness of spinal cord injury (AIS) more accurately predicts pronounced functional limitations, and ML and FT predict moderate functional limitations. The FT, a neurological level of C6 and higher, a motor score ASIA of more than 22 points are criteria for achieving moderate functional independence.
本研究的目的是调查脊髓损伤（SCI）后不同时期颈髓四肢瘫患者功能独立的临床预测因素。
190例SCI患者（151例男性和39例女性），年龄在3个月至6岁之间，纳入一项回顾性研究。平均年龄为27岁。使用脊髓损伤神经学分类国际标准（ASIA）进行检查，定义上肢的运动评分ASIA（ASIA ）、神经学（NL）和运动平面（ML）以及脊髓损伤的完整性（AIS）。使用FIM运动分量表进行功能评估。根据刺激神经肌电图（SENMG）研究正中神经的神经肌肉传导。功能独立程度评估为FIM低于42分为严重残疾，FIM为42分及以上为轻度和中度残疾。
采用逻辑回归分析发现，在SCI后的前6个月，主要预测因素是ASIA（AUC = 0.84； = 3.32； = 0.06）和NL（AUC = 0.80； = 2.96； = 0.09）。在观察的前12个月，ASIA（AUC = 0.86）仍然是主要预测因素。此外，在84.4%的病例中使用ASIA预测因素以及在81.2%的病例中使用损伤完整性（AIS）可预测明显的功能受限，在81.4%的病例中使用ASIA、在86.0%的病例中使用NL以及在100%的病例中使用功能固定（FT）可预测中度和轻度功能受限。在长期（超过12个月），预测因素ASIA（AUC = 0.92）在预测严重（82.5%）病例以及中度和轻度功能障碍（91.8%的病例）方面具有卓越的预测能力。此外，在SCI长期阶段，预测因素AIS在严重障碍（82.5%的病例）中起重要作用，而NL（88.2%）和FT（100%）在中度和轻度障碍中起重要作用。给出了SMT后12个月及超过12个月组中根据功能独立划分的功能组之间的界限：ASIA分别为22.4和22.6分，ML超过6.5以及存在ML超过5.6的FT。同时，SENMG的结果显示预测意义较低。
运动评分ASIA是SCI后所有时期的主要预测因素，而脊髓损伤的完整性（AIS）更准确地预测明显的功能受限，ML和FT预测中度功能受限。FT、C6及以上的神经平面、运动评分ASIA超过22分是实现中度功能独立的标准。
