Takeda Kazuki, Watanabe Kota, Nori Satoshi, Yamane Junichi, Kono Hitoshi, Yokogawa Noriaki, Sasagawa Takeshi, Nakashima Hiroaki, Segi Naoki, Funayama Toru, Eto Fumihiko, Furuya Takeo, Yunde Atsushi, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Terashima Yoshinori, Hirota Ryosuke, Suzuki Hidenori, Imajo Yasuaki, Ikegami Shota, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Kawaguchi Kenichi, Suzuki Nobuyuki, Uei Hiroshi, Nakanishi Kazuo, Terai Hidetomi, Inoue Gen, Kiyasu Katsuhito, Iizuka Yoichi, Akeda Koji, Funao Haruki, Oshima Yasushi, Kaito Takashi, Yoshii Toshitaka, Ishihara Masayuki, Okada Seiji, Imagama Shiro, Kato Satoshi
Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan.
Global Spine J. 2025 May;15(4):2274-2285. doi: 10.1177/21925682241297587. Epub 2024 Nov 4.
Study DesignRetrospective study.ObjectivesTo investigate the impact of diabetes mellitus on neurological recovery and determine the relationship between moderate-severe diabetes and neurological recovery in patients with cervical spinal cord injury (CSCI) without bone injury.MethodsA retrospective study was conducted on 389 consecutive patients aged ≥65 years with CSCI without bone injury across 33 medical institutes. The patients were divided into a nondiabetic group (n = 270) and a diabetic group (n = 119). Neurological outcomes were compared between the two groups through propensity score matching. The impact of moderate-severe diabetes (defined as hemoglobin A1c ≥ 7.0% or requiring insulin treatment) on neurological recovery was evaluated through multiple linear regression analysis.ResultsPropensity score matching revealed no significant differences between the diabetic and nondiabetic groups in terms of American Spinal Injury Association (ASIA) impairment scale grade and mean total ASIA motor scores (AMS) at 6 months post-injury. Multiple linear regression analysis indicated that age on admission (B = -0.34; 95% confidence interval [CI], -0.59 to -0.08; = 0.01), dementia (B = -16.50; 95% CI, -24.99 to -8.01; < 0.01), and baseline total AMS (B = -0.62; 95% CI, -0.72 to -0.51; < 0.01) were negative predictors of neurological recovery at 6 months post-injury. The presence of moderate-severe diabetes did not influence neurological recovery at 6 months post-injury.ConclusionsDiabetic patients with CSCI without bone injury achieved improvements in neurological function comparable to those of nondiabetic patients. Moderate-severe diabetes did not affect neurological recovery in patients with CSCI without bone injury.
研究设计
回顾性研究。
目的
探讨糖尿病对神经功能恢复的影响，并确定中度至重度糖尿病与无骨损伤的颈脊髓损伤（CSCI）患者神经功能恢复之间的关系。
方法
对33家医疗机构中389例年龄≥65岁、无骨损伤的CSCI连续患者进行回顾性研究。将患者分为非糖尿病组（n = 270）和糖尿病组（n = 119）。通过倾向评分匹配比较两组的神经功能结局。通过多元线性回归分析评估中度至重度糖尿病（定义为糖化血红蛋白A1c≥7.0%或需要胰岛素治疗）对神经功能恢复的影响。
结果
倾向评分匹配显示，糖尿病组和非糖尿病组在损伤后6个月时的美国脊髓损伤协会（ASIA）损伤分级和平均总ASIA运动评分（AMS）方面无显著差异。多元线性回归分析表明，入院时年龄（B = -0.34；95%置信区间[CI]，-0.59至-0.08；P = 0.01）、痴呆（B = -16.50；95%CI，-24.99至-8.01；P < 0.01）和基线总AMS（B = -0.62；95%CI，-0.72至-0.51；P < 0.01）是损伤后6个月神经功能恢复的负性预测因素。中度至重度糖尿病的存在并未影响损伤后6个月的神经功能恢复。
结论
无骨损伤的CSCI糖尿病患者神经功能改善情况与非糖尿病患者相当。中度至重度糖尿病不影响无骨损伤的CSCI患者的神经功能恢复。
