创伤性和非创伤性脊髓损伤：人口统计学特征、神经学和功能结果。一项为期7年的单中心经验。
Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience.
作者信息
Alito A, Filardi V, Famà F, Bruschetta D, Ruggeri C, Basile G, Stancanelli L, D'Amico C, Bianconi S, Tisano A
机构信息
Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy.
D.A. Research and Internationalization, University of Messina, Via Consolato Del Mare 41, 98121, Messina, Italy.
出版信息
J Orthop. 2021 Nov 20;28:62-66. doi: 10.1016/j.jor.2021.11.007. eCollection 2021 Nov-Dec.
OBJECTIVE
The aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation.
METHODS
This study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI).
RESULTS
NT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome.
CONCLUSION
SCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.
目的
本研究旨在评估受创伤性和非创伤性脊髓损伤（SCI）影响人群的人口统计学和临床特征，并分析康复后的功能结局。
方法
本研究纳入了墨西拿大学医院神经康复科收治的112例SCI患者（75例男性和37例女性）。根据美国脊髓损伤协会损伤量表（AIS）并使用住院时间、功能独立性测量（FIM）和巴氏指数（BI）对神经功能结局进行评估。
结果
与创伤性脊髓损伤（T-SCI）患者相比，非创伤性脊髓损伤（NT-SCI）患者入院时年龄显著更大、数量更多（75.89%）且损伤更严重。大多数损伤为不完全性（93%），并伴有截瘫（71%）。两组的FIM和BI结局相似，尽管T-SCI患者出院时改善更大。住院时间未发现显著差异。非创伤性SCI组最常见的并发症是尿路感染，25例患者（29.41%）出现该并发症。线性回归模型解释了住院时间方差的26%和功能结局方差的38%。入院时的功能状态是住院时间的最强决定因素，损伤的完整性是功能结局的最强决定因素。病因（创伤性与非创伤性）是住院时间的弱独立决定因素，但不是功能结局的独立决定因素。
结论
SCI患者的康复应考虑损伤的病因。在制定康复计划的目标和规划时，考虑这些信息很重要。特别是，老年对两组患者入院时的残疾程度和功能恢复程度有负面影响。与创伤性损伤相比，非创伤性损伤康复治疗后的获益可能较小。
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