急性重度颈脊髓损伤患者临床特征分析及远期死亡危险因素初探
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摘要
目的:总结重度创伤性颈脊髓损伤患者临床特征,分析影响其远期死亡的相关因素。方法:回顾性分析我院2010年1月1日～2018年5月31日收治的207例重度颈脊髓损伤患者临床特点,统计其人口学特征(性别、年龄等)、致伤因素、损伤特点(责任节段、AISA分级、合并伤等)、住院治疗情况(是否手术、手术方式、手术时机等)和并发症以及远期死亡情况,建立二元Logistic回归模型分析远期死亡的危险因素。结果:男性183例,女性24例,男女比例为7.63∶1,年龄15～74岁,平均44.7±13.7岁,以高能量损伤(包括高处坠落、车祸、重物砸伤以及其他复合伤)多见(159例,76.8%),50岁以下患者134例(64.73%),损伤节段C1～C2(3例,1.4%)、C3(28例,13.5%)、C4～C5(124例,58%)、C6(25例,12.1%)、C7(26例,12.6%)、C8(5例,2.4%),所有患者治疗受伤至住院时间3.6±3.5d,住院时间为16.2±16.9d;住院期间以呼吸系统(63例,30.4%)和水电解质紊乱(25例,12.1%)为主要并发症。8年间总死亡率为30.91%(64例),多元Logistic回归分析显示,年龄≥50岁、C1-C4损伤、保守治疗、需要呼吸机辅助呼吸是远期死亡的危险因素(P<0.05)。结论:重度创伤性颈脊髓损伤常见于中青年男性患者,损伤部位好发于C4、C5节段,以高能量暴力创伤为主;高龄、上颈椎损伤、未行手术减压及合并呼吸功能障碍易导致患者远期死亡。
Objectives: To summarize the clinical characteristics of patients with severe traumatic cervical spinal cord injury, and to analyze the predictive factors that may affect their long-term death, and to provide reference for preventive treatment. Methods: The clinical characteristics of 207 patients with severe cervical spinal cord injury admitted to our hospital from January 1, 2010 to May 31, 2018 were retrospectively analyzed. Demographic characteristics, injury factors, injury characteristics(injury factors, responsibility gaps, AIS grades, combined injuries, etc.), hospitalization and complications, and post-injury death were analyzed. Results: Male and female ratio was 7.63∶1. The average age was 44.72±13.73 years. High energy injury was the main cause of injury(including high fall, car accident, heavy body injury and other combined injuries)(159 cases, 76.8%). In 134 cases(64.73%) of the patients under the age of 50, the injured segments were C1-C2(3 cases, 1.4%), C3(28 cases, 13.5%), C4-C5(124, 58%), C6(25 cases, 12.1%), C7(26 cases, 12.6%), C8(5 cases,2.4%). All the patients were injured for 3.6±3.5 days and 16.2±16.9 days after admission, and the respiratory system failure(63 cases 30.4%) and water electrolyte disorder(25, 12.1%) were the main complications during the hospitalization. The total mortality was 30.91%(64 cases) in 8 years. Binary logistic regression analysis showed that the age over 50 years old, the C1-C4 injury, the conservative treatment, the ventilator dependence were the risk factors of long-term death(P<0.05). Conclusions: Severe traumatic cervical spinal cord injury is common in young and middle-aged male patients. The injury site occurs in the C4 and C5 segments,mainly due to high-energy violent trauma; advanced age, upper cervical spine injury, no surgical decompression and combined respiratory dysfunction are easy to cause long-term death of the patient.
Objectives: To summarize the clinical characteristics of patients with severe traumatic cervical spinal cord injury, and to analyze the predictive factors that may affect their long-term death, and to provide reference for preventive treatment. Methods: The clinical characteristics of 207 patients with severe cervical spinal cord injury admitted to our hospital from January 1, 2010 to May 31, 2018 were retrospectively analyzed. Demographic characteristics, injury factors, injury characteristics(injury factors, responsibility gaps, AIS grades, combined injuries, etc.), hospitalization and complications, and post-injury death were analyzed. Results: Male and female ratio was 7.63∶1. The average age was 44.72±13.73 years. High energy injury was the main cause of injury(including high fall, car accident, heavy body injury and other combined injuries)(159 cases, 76.8%). In 134 cases(64.73%) of the patients under the age of 50, the injured segments were C1-C2(3 cases, 1.4%), C3(28 cases, 13.5%), C4-C5(124, 58%), C6(25 cases, 12.1%), C7(26 cases, 12.6%), C8(5 cases,2.4%). All the patients were injured for 3.6±3.5 days and 16.2±16.9 days after admission, and the respiratory system failure(63 cases 30.4%) and water electrolyte disorder(25, 12.1%) were the main complications during the hospitalization. The total mortality was 30.91%(64 cases) in 8 years. Binary logistic regression analysis showed that the age over 50 years old, the C1-C4 injury, the conservative treatment, the ventilator dependence were the risk factors of long-term death(P<0.05). Conclusions: Severe traumatic cervical spinal cord injury is common in young and middle-aged male patients. The injury site occurs in the C4 and C5 segments,mainly due to high-energy violent trauma; advanced age, upper cervical spine injury, no surgical decompression and combined respiratory dysfunction are easy to cause long-term death of the patient.
引文
1.Ackery A,Tator C,Krassioukov A,et al.A global perspective on spinal cord injury epidemiology[J].J Neurotrauma,2004,21(10):1355-1370.
2.Mcdonald JW,Sadowsky C.Spinal-cord injury[J].Lancet,2002,359(9304):417-425.
3.Yugue I,Okada S,Ueta T,et al.Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury[J].Spine(Phila Pa 1976),2012,37(26):1633-1638.
4.秦江,侯树勋,石秀秀,等.2012年版“脊髓损伤后残存自主神经功能国际记录标准”简要介绍[J].中国骨与关节杂志,2014,3(9):702-704.
5.Dvorak MF,Fisher CG,Fehlings MG,et al.The surgical approach to subaxial cervical spine injuries:an evidence-based algorithm based on the SLIC classification system[J].Spine(Phila Pa 1976),2007,32(23):2620-2629.
6.Jazayeri SB,Beygi S,Shokraneh F,et al.Incidence of traumatic spinal cord injury worldwide:a systematic review[J].Eur Spine J,2015,24(5):905-918.
7.Güzelkücük,Kesikburun S,Demir Y,et al.Demographic and clinical characteristics of patients with traumatic cervical spinal cord injury:a Turkish hospital-based study[J].Spinal Cord,2014,53(6):441-445.
8.Liebscher T,Niedeggen A,Estel B,et al.Airway complications in traumatic lower cervical spinal cord injury:a retrospective study[J].J Spinal Cord Med,2015,38(5):607-614.
9.Frisbie JH.Salt wasting,hypotension,polydipsia,and hyponatremia and the level of spinal cord injury[J].Spinal Cord,2007,45(8):563-568.
10.Furlan JC,Fehlings MG.Hyponatremia in the acute stage after traumatic cervical spinal cord injury:clinical and neuroanatomic evidence for autonomic dysfunction[J].Spine(Phila Pa 1976),2009,34(5):501-511.
11.Fehlings MG,Wilson JR,Tetreault LA,et al.A clinical practice guideline for the management of patients with acute spinal cord injury:recommendations on the use of methylprednisolone sodium succinate[J].Global Spine J,2017,7(3Suppl):203-211.
12.Call MS,Kuther ME,Izenberg RA,et al.Spinal cord injury:outcomes of ventilator weaning and extubation[J].J Trauma,2001,71(6):1673-1679.
13.Como JJ,Sutton ER,McCunn M,et al.Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit[J].J Trauma,2005,59(4):912-916.
14.刘瑞端,靳安民.颈脊髓外伤后气管切开指征的影响因素分析[J].中华创伤骨科杂志,2015,17(3):213-216.
15.Nakashima H,Yukawa Y,Imagama S,et al.Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury[J].Eur Spine J,2013,22(7):1526-1532.
16.侯云飞,吕扬,周方,等.急性创伤性颈髓损伤患者气管切开预测模型[J].中国脊柱脊髓杂志,2015,25(2):148-157.
17.Liang HW,Wang YH,Lin YN,et al.Impact of age on the injury pattern and survival of people with cervical cord injuries[J].Spinal Cord,2001,39(7):375-380.
18.Alander DH,Parker J,Stauffer ES.Intermediate-term outcome of cervical spinal cord-injured patients older than 50years of age[J].Spine,1997,22(11):1189-1192.
19.Arora S,Flower O,Murray NP,et al.Respiratory care of patients with cervical spinal cord injury:a review[J].Crit Care Resusc,2012,14(1):64-73.
20.Daneshvar P,Roffey DM,Brikeet YA,et al.Spinal cord injuries related to cervical spine fractures in elderly patients:factors affecting mortality[J].J Spine,2013,13(8):862-866.
21.Liebscher T,Niedeggen A,Estel B,et al.Airway complications in traumatic lower cervical spinal cord injury:a retrospective study[J].J Spinal Cord Med,2015,38(5):607-614.
2.Mcdonald JW,Sadowsky C.Spinal-cord injury[J].Lancet,2002,359(9304):417-425.
3.Yugue I,Okada S,Ueta T,et al.Analysis of the risk factors for tracheostomy in traumatic cervical spinal cord injury[J].Spine(Phila Pa 1976),2012,37(26):1633-1638.
4.秦江,侯树勋,石秀秀,等.2012年版“脊髓损伤后残存自主神经功能国际记录标准”简要介绍[J].中国骨与关节杂志,2014,3(9):702-704.
5.Dvorak MF,Fisher CG,Fehlings MG,et al.The surgical approach to subaxial cervical spine injuries:an evidence-based algorithm based on the SLIC classification system[J].Spine(Phila Pa 1976),2007,32(23):2620-2629.
6.Jazayeri SB,Beygi S,Shokraneh F,et al.Incidence of traumatic spinal cord injury worldwide:a systematic review[J].Eur Spine J,2015,24(5):905-918.
7.Güzelkücük,Kesikburun S,Demir Y,et al.Demographic and clinical characteristics of patients with traumatic cervical spinal cord injury:a Turkish hospital-based study[J].Spinal Cord,2014,53(6):441-445.
8.Liebscher T,Niedeggen A,Estel B,et al.Airway complications in traumatic lower cervical spinal cord injury:a retrospective study[J].J Spinal Cord Med,2015,38(5):607-614.
9.Frisbie JH.Salt wasting,hypotension,polydipsia,and hyponatremia and the level of spinal cord injury[J].Spinal Cord,2007,45(8):563-568.
10.Furlan JC,Fehlings MG.Hyponatremia in the acute stage after traumatic cervical spinal cord injury:clinical and neuroanatomic evidence for autonomic dysfunction[J].Spine(Phila Pa 1976),2009,34(5):501-511.
11.Fehlings MG,Wilson JR,Tetreault LA,et al.A clinical practice guideline for the management of patients with acute spinal cord injury:recommendations on the use of methylprednisolone sodium succinate[J].Global Spine J,2017,7(3Suppl):203-211.
12.Call MS,Kuther ME,Izenberg RA,et al.Spinal cord injury:outcomes of ventilator weaning and extubation[J].J Trauma,2001,71(6):1673-1679.
13.Como JJ,Sutton ER,McCunn M,et al.Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit[J].J Trauma,2005,59(4):912-916.
14.刘瑞端,靳安民.颈脊髓外伤后气管切开指征的影响因素分析[J].中华创伤骨科杂志,2015,17(3):213-216.
15.Nakashima H,Yukawa Y,Imagama S,et al.Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury[J].Eur Spine J,2013,22(7):1526-1532.
16.侯云飞,吕扬,周方,等.急性创伤性颈髓损伤患者气管切开预测模型[J].中国脊柱脊髓杂志,2015,25(2):148-157.
17.Liang HW,Wang YH,Lin YN,et al.Impact of age on the injury pattern and survival of people with cervical cord injuries[J].Spinal Cord,2001,39(7):375-380.
18.Alander DH,Parker J,Stauffer ES.Intermediate-term outcome of cervical spinal cord-injured patients older than 50years of age[J].Spine,1997,22(11):1189-1192.
19.Arora S,Flower O,Murray NP,et al.Respiratory care of patients with cervical spinal cord injury:a review[J].Crit Care Resusc,2012,14(1):64-73.
20.Daneshvar P,Roffey DM,Brikeet YA,et al.Spinal cord injuries related to cervical spine fractures in elderly patients:factors affecting mortality[J].J Spine,2013,13(8):862-866.
21.Liebscher T,Niedeggen A,Estel B,et al.Airway complications in traumatic lower cervical spinal cord injury:a retrospective study[J].J Spinal Cord Med,2015,38(5):607-614.