非手术治疗无骨折脱位型颈脊髓损伤预后的多因素分析

目的 :探讨影响非手术治疗无骨折脱位型颈脊髓损伤预后的因素。方法 :回顾性分析2009年1月至2012年12月接受非手术治疗的122例无骨折脱位型颈脊髓损伤患者的临床资料,其中男84例,女38例;平均年龄(52.37±13.27)岁(18~83岁)。选择年龄、性别、受伤原因、受伤至治疗时间、脊髓损伤ASIA分级、MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、椎间盘突出节段、椎间盘韧带复合体损伤、大剂量甲基强的松龙冲击治疗12个可能对非手术治疗预后产生影响的因素,应用单因素和多因素Logistic回归分析,研究其对预后的影响。结果:单因素分析显示MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、椎间盘突出节段及脊髓损伤ASIA分级均对预后有显著影响(P均0.05)。进一步行多因素分析,按照其作用强度,影响预后的主要因素依次为:MRI脊髓损伤类型、脊髓损伤范围、有效颈椎管率、椎间盘突出Pfirrmann分级、脊髓损伤ASIA分级(P均0.05)。结论 :影响非手术治疗无骨折脱位型颈脊髓损伤预后的主要因素是MRI脊髓损伤类型及范围,同时与有效椎管率、椎间盘突出程度及脊髓损伤ASIA分级相关。对于选择非手术治疗需谨慎,仅适用MRI检查提示脊髓信号无改变或水肿程度轻且范围局限者,其余则建议积极手术治疗。

Multivariate analysis for prognostic factors on non-operative treatment of cervical spinal cord injury without fracture or dislocation

Objective:To analyze the factors in the non-operative treatment of cervical spinal cord injury without fracture or dislocation. Methods:The clinical data of 122 patients with cervical spinal cord injury without fracture or dislocation from January 2009 to December 2012 treated by non-operative treatment were retrospectively reviewed. There were 84 males and 38 females, aged from 18 to 83 years with an average of(52.37±13.27) years. The clinical features, such as age, gender, cause of injury, time from injury to treatment, ASIA grade of spine cord injury, MRI type of spine cord injury, range of spine cord injury, effective cervical spinal canal ratio, Pfirrmann grade of intervertebral disc herniation, segment of intervertebral disc herniation, intervertebral disc ligament complex injury, treatment of high-dose methylprednisolone, were observed. Single factor and multiple factor Logistic regression analysis were used in the clinical data in order to analyze the influencing factors of above items to prognosis. Results:For univariate analysis, the factors such as MRI type of spine cord injury, extent of spine cord injury, effective cervical spinal canal ratio, Pfirrmann grade of intervertebral disc herniation, segment of intervertebral disc herniation, ASIA grade of spine cord injury, associated with prognosis (P<0.05). Multiple linear regression analysis showed that the main prognostic factors including MRI type of spine cord injury, range of spine cord injury, effective cervical spinal canal ratio, Pfirrmann grade of intervertebral disc herniation, ASIA grade of spine cord injury according to its effective intension(P<0.05). Conclusion:The main prognostic factors on non-operative treatment of cervical spinal cord injury without fracture or dislocation were MRI type and extent of spine cord injury, meanwhile, correlate with effective cervical spinal canal ratio, Pfirrmann grade of intervertebral disc herniation, ASIA grade of spine cord injury. It is deliberative to choose no-operative treatment, for it only refers to the patients with the mild localized edema type or no signal change of spinal cord in MRI. Operative treatment should be recommended for other patients.