Tsuji Osahiko, Suda Kota, Michikawa Takehiro, Takahata Masahiko, Ozaki Masahiro, Konomi Tsunehiko, Matsumoto Harmon Satoko, Komatsu Miki, Ushiku Chikara, Menjo Yusuke, Iimoto Seiji, Watanabe Kota, Nakamura Masaya, Matsumoto Morio, Minami Akio, Iwasaki Norimasa
Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan.
J Orthop Sci. 2023 Nov;28(6):1227-1233. doi: 10.1016/j.jos.2022.10.007. Epub 2022 Nov 2.
Although the prognosis of incomplete cervical spinal cord injury (SCI) diagnosed as American Spinal Injury Association Impairment Scale grade C (AIS C) is generally favorable, some patients remain non-ambulatory. The present study explored the clinical factors associated with the non-ambulatory state of AIS C patients.
This study was a single-center retrospective observational study. Seventy-three participants with AIS C on admission were enrolled and divided into two groups according to ambulatory ability after one year. Prognostic factors of SCI were compared in ambulatory (A-group) and non-ambulatory participants (NA-group). Univariable and multivariable logistic regression analyses were performed on demographic information, medical history, mechanism of injury, presence of fracture, ASIA motor scores (MS) of the extremities, neurological findings, including an anorectal examination on admission, and imaging findings.
Forty-one patients were included in the A-group and 32 in the NA-group. Univariable analysis revealed that the following factors were related to poor outcomes (p < 0.05): older age, history of cerebrovascular disorder, impairment/absence of S4-5 sensory score, deep anal pressure (DAP) (-), voluntary anal contraction (VAC) (-), anorectal tone (-), anal wink reflex (-), and low MS of the upper and lower extremities. In the multivariable analysis using age, presence or absence of sacral abnormality, and history of cerebrovascular disorders (adjusted for these three factors), older age and presence of sacral abnormality on admission were independent risk factors for a non-ambulatory state at the 1-year follow-up.
Incomplete AIS C SCI individuals with older age and/or impairment of anorectal examination could remain non-ambulatory at 1-year follow-up.
虽然诊断为美国脊髓损伤协会损伤分级C级（AIS C）的不完全性颈脊髓损伤（SCI）患者的预后总体较好，但仍有一些患者无法行走。本研究探讨了与AIS C级患者无法行走状态相关的临床因素。
本研究为单中心回顾性观察研究。纳入73例入院时为AIS C级的参与者，并根据一年后的行走能力分为两组。比较了可行走参与者（A组）和不可行走参与者（NA组）的SCI预后因素。对人口统计学信息、病史、损伤机制、骨折情况、四肢的亚洲脊髓损伤协会运动评分（MS）、神经学检查结果（包括入院时的肛门直肠检查）和影像学检查结果进行了单变量和多变量逻辑回归分析。
A组纳入41例患者，NA组纳入32例患者。单变量分析显示，以下因素与不良预后相关（p < 0.05）：年龄较大、脑血管疾病史、S4-5感觉评分受损/缺失、深部肛门压力（DAP）（-）、自主肛门收缩（VAC）（-）、肛门直肠张力（-）、肛门反射（-）以及上下肢MS较低。在使用年龄、骶骨异常的有无和脑血管疾病史（对这三个因素进行校正）的多变量分析中，年龄较大和入院时存在骶骨异常是1年随访时无法行走状态的独立危险因素。
年龄较大和/或肛门直肠检查受损的不完全性AIS C级SCI患者在1年随访时可能仍无法行走。
