关键词:

创伤性颈髓损伤, 手术时机, 疗效, 影响因素

Abstract:

Objective To compare the efficacy of acute traumatic cervical spinal cord injury patients with AIS grade C and D under different surgical timing，and to analyze the related factors affecting the surgical timing. Methods Retrospective analysis was performed on the patients with acute traumatic cervical spinal cord injury （TCSCI）in our hospital from March 2013 to April 2021，who rated as American Spinal Injury Association Injury Scale（AIS）grade C and D. The patients who had been followed up for more than 6 months in the last outpatient clinic were divided into three groups based on operation timing：group A less than 48 hours，group B more than 48 hours and less than 1 week，and group C more than 1 week. Collect the case data in the three groups after admission，including：gender，age，injury cause，injury plane，AIS grade，AMS score（ASIA Motor Score）at admission，AMS at 6 months after surgery，and improvemental score of AMS after surgery. Compare and contrast the three groups′ AMS improvement scores following surgery. Regression analysis was performed on related factors affecting the surgical timing. Results A total of 79 patients were enrolled，including 28 patients with AIS grade C and 51 patients with AIS grade D at admission as well as 60 males and 19 females with an average age of（49.87 ± 11.18）years old. There were 11 high fall injuries，33 motor vehicle collisions，8 heavy bruises，and 27 cases of falling down. The damage plane with C1⁃4 and C5⁃8 was 60 and 19 cases respectively. Group A had 21 cases， Group B had 31 cases，and Group C had 27 cases. There were no significant differences in gender，age，the causes of trauma，AIS grade，preoperative and postoperative AMS，and injury plane among the three groups. At the lastpostoperative follow⁃up，there were significant differences in AMS scores between groups A，B，and C（P = 0.04）. There was no statistically significant difference between groups B and C. Ordered multiple Logistic analysis showed that the factors that prolonged the timing of surgery included：early respiratory complications（OR = 2.89），associ⁃ ated injury（OR = 4.39），basic diseases of internal medicine（OR = 6.25），the number of white blood cells in labo⁃ ratory was more than 10 × 109 /L（OR = 5.50）. Conclusions Acute traumatic cervical spinal cord injury patients with AIS grades C and D fare much better within 48 hours of surgery. The most significant factor contributing to the operation time delay was basic diseases of internal medicine. 

Key words: traumatic cervical spinal cord injury,  , operation timing,  , efficacy,  , influencing factors