摘要
目的 分析手术治疗颈脊髓中央损伤综合征的预后及相关影响因素.方法 回顾性选取2021年2月至2023年2月泸州市人民医院颈脊髓中央损伤综合征患者100例,依据手术预后分为预后良好组(n=70)、预后不良组(n=30).统计分析两组患者的一般资料[性别、年龄、致伤原因、受伤至手术时间、手术方式、入院和末次随访日本矫形学学会(JOA)评分、美国脊髓损伤协会(ASIA)神经功能评分、ASIA感觉、运动评分、手内肌肌力评分、住院时间、影像学资料等],多元回归分析一般资料与ASIA感觉、运动评分改善率、JOA评分改善率、预后良好的情况,并分析预后良好的相关影响因素、临界值.结果 两组患者的性别构成比、病理征、椎间盘突出、后方韧带损伤、发育性颈椎管狭窄、手术方式、受伤至手术时间、住院时间、髓内高信号范围、脊髓受压最大处矢状径、脊髓最大受压程度(MSCC)之间比较,差异均无统计学意义(P＞0.05);预后良好组患者的年龄、椎前高信号比率、后纵韧带骨化比率、椎管最狭窄处矢状径、MCC均明显低于预后不良组,差异均有统计学意义(P＜0.05);预后良好组患者的入院时手内肌评分、ASIA运动评分和JOA评分均明显高于预后不良组,差异均有统计学意义(P＜0.05).预后良好的相关影响因素包括椎前高信号、椎管最狭窄处百分比、入院时手内肌评分、入院ASIA运动评分、入院JOA评分(P＜0.05).MCC预测手术治疗颈脊髓中央损伤综合征预后的灵敏度和特异度最高(P＜0.05).结论 手术治疗颈脊髓中央损伤综合征的预后良好率高,MCC为主要相关影响因素.
Abstract
Objective To analyze the prognosis and related influencing factors of surgical treatment for central cervical spinal cord injury syndrome.Methods A retrospective selection was conducted on 100 patients with central cervical spinal cord injury syndrome in Luzhou People's Hospital from February 2021 to February 2023.They were divided into two groups based on surgical prognosis:the good prognosis group(n=70)and the poor prognosis group(n=30).The general data[gender,age,cause of injury,time from injury to operation,surgical method,Jap-anese Orthopaedic Association(JOA)score at admission and last follow-up,American Spinal Injury Association(ASIA)neurological function score,ASIA sensory and motor score,hand muscle strength score,hospitalization time,imaging data,etc.]of the two groups of patients were statistically analyzed.multiple regression analysis of general data with ASIA sensation,movement score improvement rate,JOA score improvement rate,and good prognosis,and analysis of relevant influencing factors and critical values for good prognosis.Results There were no significant differences in gender composition ratio,pathological signs,disc herniation,posterior ligament injury,developmental cervical spinal stenosis,sur-gical method,time from injury to operation,hospitalization time,intramedullary high signal range,sagittal diameter of the maximum spinal cord compression,and maximum spinal cord compression(MSCC)between the two groups(P＞0.05).The age,pre vertebral high signal ratio,pos-terior longitudinal ligament ossification ratio,sagittal diameter of the narrowest spinal canal,and percentage of the narrowest spinal canal in the group with good prognosis were significantly lower than those in the group with poor prognosis(P＜0.05);At admission,the hand muscle score,ASIA motor score,and JOA score were significantly higher than those in the poor prognosis group,with significant differences(P＜0.05).The relevant influencing factors for a good prognosis include pre vertebral hyperintensities,percentage of spinal canal stenosis,hand muscle score upon admission,ASIA motor score upon admission,and JOA score upon admission(P＜0.05).The percentage of spinal canal stenosis predicts the highest sensitivity and specificity in predicting the prognosis of surgical treatment for central cervical spinal cord injury syndrome(P＜0.05).Conclusion Central cervical spinal cord injury syndrome surgical treatment has a high prognosis rate,and the main influencing factor is the per-centage of the narrowest spinal canal.
维普
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