Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.
Clin Spine Surg. 2022 Nov 1;35(9):E731-E736. doi: 10.1097/BSD.0000000000001362. Epub 2022 Jun 29.
This was a level IV retrospective prognostic study.
The objective of this study was to determine if patients with chronic diabetes have worse functional outcomes and motor recovery after cervical traumatic spinal cord injury (TSCI).
Diabetes mellitus has multiple deleterious neurological effects and has been shown to worsen elective cervical spine surgery outcomes. Prior literature has scarcely characterized the impact of chronic diabetes on motor and functional outcomes after TSCI.
The National Spinal Cord Injury Statistical Center (NSCISC) database was utilized to retrospectively collect data on cervical American Spinal Injury Association (ASIA) C TSCI between 2011 and 2016. Patients were divided into diabetes and nondiabetes groups. Primary outcomes included wheelchair requirement and ambulatory status 1 year after injury. Secondary outcomes were motor score collected at the time of rehab admission, rehab discharge, and 1-year follow-up. All outcome variables were analyzed using univariate and multivariate regression to assess for differences between diabetes and nondiabetes groups and possible confounders.
A total of 219 patients met the inclusion criteria for the study: 193 without diabetes and 26 with diabetes (12.0%). After controlling for confounders, patients with diabetes had had significantly increased wheelchair requirement (83.3% vs. 51.8%, relative risk=1.63, 95% confidence interval: 1.20-1.83, P =0.009 multivariate) and decreased ambulatory rates (50% vs. 67.9%, relative risk=0.55, 95% confidence interval: 0.25-0.98, P =0.042 multivariate) at 1 year. They also had no difference in average total motor scores at rehab admission but significantly worse total motor scores at rehab discharge (50.6±23.3 vs. 60.3±21.4, P =0.033 univariate, P =0.002 multivariate).
Patients with diabetes have increased wheelchair requirement and decreased ambulatory ability at 1 year after the injury as well as diminished recovery in motor scores after motor-incomplete cervical TSCI. These patients may be targets for aggressive diabetic screening and intervention to minimize negative outcomes.
这是一项四级回顾性预后研究。
本研究的目的是确定患有慢性糖尿病的患者在发生颈外伤性脊髓损伤（TSCI）后是否功能预后更差，运动恢复更差。
糖尿病具有多种有害的神经作用，并已被证明会使择期颈椎手术的结果恶化。先前的文献几乎没有描述慢性糖尿病对 TSCI 后运动和功能预后的影响。
利用国家脊髓损伤统计中心（NSCISC）数据库，回顾性收集 2011 年至 2016 年期间颈外伤性美国脊髓损伤协会（ASIA）C 级 TSCI 的数据。患者分为糖尿病组和非糖尿病组。主要结果包括损伤后 1 年时的轮椅需求和活动能力。次要结果是康复入院时、康复出院时和 1 年随访时的运动评分。使用单变量和多变量回归分析来评估糖尿病组和非糖尿病组之间的差异以及可能的混杂因素。
共有 219 名患者符合研究纳入标准：193 名无糖尿病，26 名有糖尿病（12.0%）。在控制混杂因素后，糖尿病患者的轮椅需求明显增加（83.3%比 51.8%，相对风险=1.63，95%置信区间：1.20-1.83，P=0.009 多变量），活动能力下降（50%比 67.9%，相对风险=0.55，95%置信区间：0.25-0.98，P=0.042 多变量）1 年。他们在康复入院时的平均总运动评分上没有差异，但在康复出院时的总运动评分明显更差（50.6±23.3 比 60.3±21.4，P=0.033 单变量，P=0.002 多变量）。
患有糖尿病的患者在受伤后 1 年内需要更多的轮椅，活动能力下降，运动不完全性颈外伤性脊髓损伤后的运动评分恢复减少。这些患者可能是积极筛查和干预糖尿病的目标，以最大限度地减少不良后果。
