School of Medicine, Spine Center, University of California San Francisco, San Francisco, California, USA.
Department of Neurological Surgery, Spine Center, University of California San Francisco, San Francisco, California, USA.
J Neurotrauma. 2022 Aug;39(15-16):1030-1038. doi: 10.1089/neu.2021.0375. Epub 2022 Mar 25.
Spinal cord injuries (SCIs) frequently occur in combination with other major organ injuries, such as traumatic brain injury (TBI) and injuries to the chest, abdomen, and musculoskeletal system (e.g., extremity, pelvic, and spine fractures). However, the effects of appendicular fractures on SCI recovery are poorly understood. We investigated whether the presence of SCI-concurrent appendicular fractures is predictive of a less robust SCI recovery. Patients enrolled in the Transforming Research and Clinical Knowledge in SCI (TRACK-SCI) prospective cohort study were identified and included in this secondary analysis study. Inclusion criteria resulted in 147 patients, consisting of 120 with isolated SCIs and 27 with concomitant appendicular fracture. The primary outcome was American Spinal Injury Association (ASIA) Impairment Scale (AIS) neurological grades at hospital discharge. Secondary outcomes included hospital length of stay, intensive care unit (ICU) length of stay, and AIS grade improvement during hospitalization. Multivariable binomial logistical regression analyses assessed whether SCI-concomitant appendicular fractures associate with SCI function and secondary outcomes. These analyses were adjusted for age, gender, injury severity, and non-fracture polytrauma. Appendicular fractures were associated with more severe AIS grades at hospital discharge, though covariate adjustments diminished statistical significance of this effect. Notably, non-fracture injuries to the chest and abdomen were influential covariates. Secondary analyses suggested that appendicular fractures also increased hospital length of stay. Our study indicated that SCI-associated polytrauma is important for predicting SCI functional outcomes. Further statistical evaluation is required to disentangle the effects of appendicular fractures, non-fracture solid organ injury, and SCI physiology to improve health outcomes among SCI patients.
脊髓损伤（SCI）常与其他主要器官损伤同时发生，如创伤性脑损伤（TBI）以及胸部、腹部和肌肉骨骼系统（如四肢、骨盆和脊柱骨折）损伤。然而，四肢骨折对 SCI 恢复的影响知之甚少。我们研究了 SCI 合并四肢骨折是否预示着 SCI 恢复较差。确定并纳入了转化研究和临床知识在 SCI 中的前瞻性队列研究（TRACK-SCI）中的患者进行这项二次分析研究。纳入标准导致 147 名患者，包括 120 名单纯 SCI 患者和 27 名合并四肢骨折的患者。主要结局是医院出院时美国脊髓损伤协会（ASIA）损伤量表（AIS）神经学分级。次要结局包括住院时间、重症监护病房（ICU）入住时间以及住院期间 AIS 分级改善。多变量二项逻辑回归分析评估了 SCI 合并四肢骨折与 SCI 功能和次要结局的关系。这些分析调整了年龄、性别、损伤严重程度和非骨折多发伤。四肢骨折与医院出院时更严重的 AIS 分级相关，但协变量调整降低了这种影响的统计学意义。值得注意的是，胸部和腹部的非骨折损伤是有影响力的协变量。二次分析表明，四肢骨折也增加了住院时间。我们的研究表明，与 SCI 相关的多发伤对预测 SCI 功能结局很重要。需要进一步的统计评估来理清四肢骨折、非骨折实体器官损伤和 SCI 生理学的影响，以改善 SCI 患者的健康结局。
