创伤性脊髓损伤康复治疗最佳介入时间窗观察

目的 观察不同介入时机康复治疗对创伤性脊髓损伤患者日常生活活动能力以及运动功能的影响，探讨康复治疗的最佳时间窗。方法 收集我院2015年10月~ 2017年7月收治的符合纳入标准的创伤性脊髓损伤患者55例，按介入的时间不同分为早期组（脊髓休克期过后2~4周内）和对照组（脊髓休克期过后4~8周内），两组采用标准康复训练方法，即根据两组患者不同病程、不同损伤阶段及程度，采用不同的训练方法，同时配以相应的物理治疗及心理治疗。所有患者的康复治疗时间均为3个月。分别于康复治疗前（脊髓休克期过后）及康复治疗3个月后进行运动功能（ASIA运动评分）及日常生活活动能力评定（Barthel评分）。结果 康复治疗后，两组患者Barthel指数及ASIA运动评分较治疗前均提高，差异有统计学意义（P＜0.01）；治疗后，早期组Barthel指数[（67.67±27.97）分 vs （53.60±26.52）分]及ASIA运动分[（66.60±25.34）分 vs （53.24±23.72）分]均高于对照组，差异有统计学意义（P＜0.01）；在相关性研究中，早期组Barthel指数增加值与ASIA 运动评分增加值成显著正相关（P＜0.01），而在对照组中呈低度正相关（P＜0.05）。结论 脊髓休克后2~4周是一个更好的康复治疗介入的时间窗。

Observation on the Best Interventional Time Window for Rehabilitation of Traumatic Spinal Cord Injury

Abstract:Objective To observe the effects of rehabilitation on the activities of daily life and motor function in patients with traumatic spinal cord injury and to explore the best time window for rehabilitation.Methods 55 patients with traumatic spinal cord injury admitted to our hospital from October 2015 to July 2017 were collected.According to the time of intervention,they were divided into early group(within 2 to 4 weeks after shock of spinal cord)and control group(within 4 to 8 weeks after shock of spinal cord).The two groups were treated with standard rehabilitation training method,that is,according to different course of disease,different stage and degree of injury.Different training methods were used,and corresponding physiotherapy and psychotherapy were used at the same time.All patients were treated for 3 months.The exercise function(ASIA exercise score)and the activity of daily living(Barthel score)were performed before rehabilitation(after spinal cord shock)and after 3 months of rehabilitation.Results After rehabilitation, both Barthel index and ASIA exercise score were significantly higher in the two groups than before treatment,the difference was statistically significant(P<0.01);After treatment,the early group Barthel index[(67.67±27.97)points vs(53.60±26.52)points]and ASIA movement [(66.60±25.34)points vs(53.24±23.72)points]was higher than the control group,the difference was statistically significant(P<0.01);in the correlation study,the early Barthel group the index value added score and ASIA motion to increase the value of a significant positive correlation(P<0.01),while in the control group showed positive correlation(P<0.05).Conclusion 2~4 weeks after spinal shock is a better time window for rehabilitative intervention.