| 影响无骨折脱位型颈脊髓损伤手术疗效的多因素分析 |
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投稿时间：2019-06-11
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| 作者 | Author | 单位 | Address | E-Mail |
| 李洪 |
LI Hong |
川北医学院附属医院骨科, 四川 南充 637000 |
Department of Orthopaedics, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China |
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| 蒋成 |
JIANG Cheng |
川北医学院附属医院骨科, 四川 南充 637000 |
Department of Orthopaedics, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan, China |
641876394@qq.com |
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| 期刊信息：《中国骨伤》2020年，第33卷，第2期，第158-165页 |
| DOI：10.12200/j.issn.1003-0034.2020.02.014 |
| 基金项目: |
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中文摘要:
目的：探讨影响无骨折脱位型颈脊髓损伤手术疗效的相关因素。
方法：对2010年11月至2016年11月被诊断为无骨折脱位型颈脊髓损伤且接受手术治疗69例患者的临床资料进行回顾性分析，其中男37例，女32例；年龄32~76（51.6±7.3）岁。选择年龄、性别、脊髓损伤ASIA分级、MRI中脊髓损伤长度、Pavlov比值、后纵韧带骨化、椎间盘突出、MRI中脊髓损伤类型、受伤至手术时间、大剂量激素冲击治疗、手术时间、术中出血量12个因素，应用SPSS 22.0软件对数据进行Logistic单因素和多因素分析，筛选出影响手术疗效的各因素，并确定主要影响因素。
结果：单因素分析显示脊髓损伤ASIA分级、MRI中脊髓损伤长度、Pavlov比值、后纵韧带骨化、椎间盘突出、MRI中脊髓损伤类型均与手术疗效相关（P<0.05）。对筛选出的因素行多因素分析显示：按照作用强度，影响手术疗效的因素依次为MRI中脊髓损伤类型、MRI中脊髓损伤长度、Pavlov比值、脊髓损伤ASIA分级（P<0.05）。
结论：影响无骨折脱位型颈脊髓损伤手术疗效的因素为MRI中脊髓损伤类型、MRI中脊髓损伤长度、Pavlov比值、脊髓损伤ASIA分级，其中最主要的因素为MRI中脊髓损伤类型和长度。相较于其他患者，术前MRI提示脊髓损伤类型为水肿+出血或者损伤长度≥ 45 mm的患者，手术疗效欠佳的风险更高，术前需与患者及家属充分沟通。 |
| 【关键词】无骨折脱位型颈脊髓损伤 外科手术 预后因素 多因素分析 |
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| Multivariate analysis of the operative effect on cervical spinal cord injury without fracture or dislocation |
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ABSTRACT
Objective: To explore the influencing factors of the operative effect on cervical spinal cord injury without fracture or dislocation.
Methods: The clinical data of 69 patients with cervical spinal cord injury without fracture or dislocation from November 2010 to November 2016 who received operation were retrospectively analyzed. There were 37 males and 32 females,aged from 32 to 76 years with an average of(51.6±7.3) years. The clinical data of 12 factors were selected,including age,gender,ASIA grade of spine cord injury,the length of spine cord injury by MRI,Pavlov ratio,ossification of the posterior longitudinal ligament(OPLL),intervertebral disc herniation,type of spine cord injury by MRI,time from injury to operation,treatment of high-dose methylprednisolone,operation time,intraoperative bleeding volume. In order to screen the main influencing factors of above items to prognosis,the single factor and multiple factor Logistic regression analysis were used in the clinical data by SPSS 22.0 statistical software.
Results: Univariate analysis results showed that the factors including ASIA grade of spine cord injury,the length of spine cord injury by MRI,Pavlov ratio,ossification of longitudinal ligament,intervertebral disc herniation,the type of spine cord injury by MRI were associated with prognosis(P<0.05). Multi factor analysis of the selected factors indicated that the type of spine cord injury by MRI,the length of spine cord injury by MRI,Pavlov ratio,ASIA grade of spine cord injury were the main prognostic factors according to the influence intensity(P<0.05).
Conclusion: The influencing factors of the operative effect on cervical spinal cord injury without fracture and dislocation were the type of spine cord injury by MRI,the length of spine cord injury by MRI,Pavlov ratio,ASIA grade of spine cord injury,and the foremost were the type and length of spine cord injury by MRI. Compared with other patients,preoperative MRI showed the patient with spinal cord injury type with bleeding and edema,or the length of spine cord injury larger than 45 mm may be less effective,therefore,it is necessary to thoroughly communicate with the patients and their kin before surgery. |
| KEY WORDS Cervical spinal cord injury without fracture or dislocation Surgery Prognostic factors Multiplicity |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李洪,蒋成.影响无骨折脱位型颈脊髓损伤手术疗效的多因素分析[J].中国骨伤,2020,33(2):158~165 |
| 英文格式: | LI Hong,JIANG Cheng.Multivariate analysis of the operative effect on cervical spinal cord injury without fracture or dislocation[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(2):158~165 |
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