谢斌华,李青
XIE Binhua,LI Qing

• 1:贵州医科大学急诊医学教研室
• 2:贵州医科大学附院

摘要(Abstract)：

目的:观察颈椎损伤并发脊髓损伤手术治疗的预后,分析其影响因素。方法:收集100例急性颈椎损伤并发脊髓损伤患者年龄、受伤至就诊时间、受伤至手术时间、是否合并损伤、伤后8 h内是否使用糖皮质激素、是否颈托保护、是否为完全损伤、椎管侵占率等资料,术后随访9~24月,比较患者治疗前后神经功能分级;利用单因素分析筛选可能影响脊髓损伤手术治疗预后的因素再进行Logistic分析,筛选影响脊髓损伤预后的主要因素。结果:100例颈椎损伤并发脊髓损伤中,失访16例,随访率84%;术后获得脊髓功能恢复46例(55%),未获得脊髓功能恢复38例(45%);单因素分析显示受伤至就诊时间、受伤至手术时间、是否合并损伤、伤后8 h内是否使用糖皮质激素、是否颈托保护、是否为完全损伤、椎管侵占率与脊髓损伤预后有相关性,Logistic回归分析表明受伤至手术时间、是否为完全损伤、椎管侵占率及伤后8 h内是否使用糖皮质激素是影响脊髓损伤预后的主要因素(P<0.05)。结论:正确的入院前急救、合适的手术时机、充分的脊髓减压、伤后8 h内激素冲击治疗可以有效改善颈椎损伤并发脊髓损伤患者治疗后的神经功能。
Objective: To investigate the factors influencing prognosis in surgical treatment of cervical spinal injury combined with spinal cord injury so as to assist in the clinical treatment. Methods: A retrospective study was made on 100 cases of acute thoracolumbar spinal injury combined with spinal cord injury,analyzing materials contained: age of patients,time of injury and admitting,time of injury and surgery,whether combined injury,treated with GC of not within 8 hr of injury,cervical collar or not,whether total injury or not,spinal canal occupying ratio. Follow up visit for 9 to 24 months in order to compare neuro function classification before and after treatment; potential factors affecting the prognosis of spinal cord injury were identified using univariate analysis and incorporated into the Logistic regression equation to filter out the main influencing factors,filtering major factors influencing prognosis of spinal cord injury. Results: 100 cases were indicated,16 cases lost contact and the follow-up rate was84 %. 46 cases recovered spinal cord function( 55 %),38 cases failed to recover spinal cord function(45%). Univariate analysis indicated time of injury and admitting,time of injury and surgery,whether combined injury,treated with GC of not within 8 hr of injury,cervical collar or not,whether total injury or not,spinal canal occupying ratio all share correlation with spinal cord injury prognosis. Logistic regression analysis revealed time of injury and surgery,whether total injury or not,treated with GC of not within 8 hr of injury,spinal canal occupying ratio are the major factors to influence spinal cord injury prognosis( P < 0. 05). Conclusion: Effective pre-hospital first aid and appropriate surgical intervention,adequate decompression and steroids applying within 8 hours after injury may effectively improve the prognosis of spinal cord injury with cervical spinal fractures or dislocations.

关键词(KeyWords)： 颈椎损伤;脊髓损伤;外科手术;预后;影响因素
spinal injuries;spinal cord injuries;surgical procedures,operative;prognosis;influence factors

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技合作计划项目[黔科合LH字(2014)7149]

作者(Author): 谢斌华,李青
XIE Binhua,LI Qing

DOI: 10.19367/j.cnki.1000-2707.2017.01.018

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